Appointment with clinical psychologist

I had an appointment with my clinical psychologist, B, today. I felt really good afterwards though that has faded a little now. I think it would be useful for me if I wrote about the appointments, preferably on the day, to help me remember as much of the information as possible.

First of all B went over the plan for the appointment. In my first CBT course, I made up an agenda at the beginning of the appointment. This has the same function of planning out the appointment. It saves some time if she does it though and I do feel like I have a say which I think was the point of me doing the agenda myself. Also, I like that she is steering the appointment. I did used to feel unsettled a bit at times in my first CBT course.

Secondly, she asked me about how I had been in the three weeks since my last appointment. I said I am feeling a lot better. Most of the symptoms are less intense and are certainly less overwhelming. I’m functioning a lot better and starting to enjoy things again which is such a difference and such a relief. I said I had increased the quetiapine myself from 100mg to 300mg without Dr W’s knowledge. I said I’d been to my GP, Dr McD, twice and that the new plan was to see the consultant, Dr S, as an outpatient and not to return to the Day Service. Instead I’m going to concentrate more on the psychological work, things with my support worker S, and lifestyle changes. Actually I don’t know if I did say the bit about lifestyle changes but I’m meaning to do that (as fucking ever). She seemed okay with that though didn’t say a lot.

Thirdly, she asked me to read over her letter to Dr S (as that’s who referred me to her). It was fine except that she had written that my mother has bipolar disorder, that I had told the Day Service staff nurse F that I wasn’t sure about doing psychology with her (I’ll save that for a separate rant) and a couple of other little points. I think I’ve confused the hell out of people over the years with my family history. My way is to give doctors, nurses, etc, all the information I can, even random little bits that are probably totally irrelevant, just in case it turns out to be important. So it was handy that I got to read the letter and sort that out. The type of psychotherapy I’m doing is schema therapy which I think is a type of CBT that is particularly useful if you have problems that started when you were a child. Also, she’s going to give me a corrected copy of the letter at the next appointment.

Finally, she asked me about my homework which was to read Paul Gilbert’s Overcoming Depression up to page 138 and do some thought forms.

I said I hadn’t managed all the reading and had only read up to page 69 plus pages 117-119 when I was doing thought forms. She reassured me that this was fine. I said I felt I was reading it quite thoroughly and was writing down quotes that I found particularly good. She suggested writing some of these on flash cards or on paper that I carried in my wallet. Then I talked about how helpful and comforting I was finding Overcoming Depression. In particular I found the evolutionary basis of depression greatly comforting as it kept reinforcing to me that my depression isn’t evidence that I am fundamentally broken. Aspects of depression have evolved in humans because they are actually protective in some situations though nowadays they are commonly a hindrance. Basically as I read I kept hearing “It’s not all your fault. It’s not all your fault.”

Then we went over the thought forms. I thought I hadn’t done enough though I can’t remember now if I said that. I did eight and we only just managed to finish going over them and she certainly didn’t suggest that I hadn’t done enough. In fact she said I’d done really well and I even managed to say thank you (and surprised myself).

In the column called ‘Automatic Thought’ it looks like it is important to see if the thoughts have come from either of my schemas (the defectiveness schema [“I’m broken”, “I’m ugly”, etc] and the social isolation schema [“I don’t fit in”, “I don’t belong”, etc]). Most of these ones did and were usually from the defectiveness schema.

I was worried beforehand that I’d be embarrassed talking about my weight and feeling fat with her because she’s thin and I’m so ashamed of being fat but it was actually okay. Now I feel quite relieved and like if I have to talk about it again it’ll be okay. She was quite emphatic that a thin or beautiful person isn’t necessarily a good, nice or kind person – she said “look at Naomi Campbell” who has been spitting at policemen. When she read out my automatic thought “I’m just like a monster” she sounded a bit shocked. I am worried that she suspects I have more eating problems that I have talked about. This is true as I would really like to ‘restrict’, i.e. diet strictly, and loose weight quickly. What’s stopping me isn’t really the health implications of restricting (though it is a little especially the thought of getting osteoporosis) but the lack of motivation. I can feel my motivation coming back. I should be frightened not pleased.

Anyway, back to the appointment. She asked if the critical voices were like the bullies when I was at school and if I’d found that calling myself the same names had made the bullies’ name-calling hurt a bit less. Oh my fucking god that is so true! I definitely remember kind of ‘practicing’ calling myself names and noticing that when other people called me those things it didn’t get to me as much.

We talked about my recurrent argument with my OH, J, about the flat, his sister’s stuff here and his family. I’m worried that J’s sister doesn’t want the rats here but isn’t saying anything. The psychologist pointed out that it is J’s sister’s responsibility to say what she wants and assert herself. She also said that most people would find my situation with this flat unsettling which made me feel better.

My homework this week is to continue reading Overcoming Depression, though she didn’t suggest a page number this time, and continue doing thought forms.

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