In the first two appointments (7th December 2007 and 20th December 2007) that I had with the clinical psychologist, B, she took my history. I was struggling a lot with just talking so it took some time. Also, she asked me to write out goals that I wanted to achieve. I simply gave her the same goals that I had made for the CBT course that I was supposed to do last summer with Dr McL. These are:
1. Improve my self-esteem.
– Improve motivation in making positive changes in my life.
– Improve self-reliance and self-confidence and reduce self-doubt so reducing dependency on others for reassurance.
– Improve confidence in making my own decisions.
– Reduce reliance on what other people think when I make decisions.
2. Reduce the risk of relapses.
– Learn more about relapse prevention.
– Make strategies for asking for help including what to say and to who.
3. Improve my management of troublesome symptoms.
– Improve my management of irritability.
– Improve my management of depersonalization.
– Improve my management of shame associated with my illness.
– Try to feel healthy disappointment and regret rather than guilt and shame about things I feel I have lost to my illness.
– Improve my management of pessimistic negative automatic thoughts.
4. Improve my management of perfectionism.
– Improve my recognition of how perfectionism affects me.
– Reduce self-sabotage with perfectionism.
I made it to an appointment on 18th January 2008 but then cancelled (at the very last minute) the one on 1st February 2008 and defaulted on 13th February 2008. B ended up phoning the Day Service staff nurse, F, about me that day. The letters/leaflets from clinical psychology were very clear that it didn’t tolerate defaulting so I knew I was going to be in trouble. My next appointment was 6th March 2008 and B was not happy with me at all. Actually I really respected how firm she stood on the department’s policy. I managed to convince her that I did want to continue psychotherapy and that I was serious about it. But I know I have to make a serious effort with attendance. Since then I have made it to appointments on 14th March 2008 and today.
B said several interesting things – one of the major reasons for this blog is to record them! She said there is a difference between internalising your illness and not accepting it. Accepting that you have a mental illness does not mean that it becomes part of you or part of your personality. I need to think about that more as I don’t think I’ve got that yet.
Another thing is that she seemed to categorise my excessive sleeping as an unhealthy or maladaptive coping strategy like self-harm or taking drugs. I was pretty offended by that actually. Surely self-harm, etc, is much worse than simply sleeping too much? I asked J what he thought and I was surprised how readily he agreed with the psychologist. As did my mother and my sister. So I thought again. I still don’t think self-harm, etc, is as bed as sleeping too much but I agree it’s the same idea and from the same place.
B also thinks that my depersonalisation is a maladaptive coping strategy. I feel that she thinks I have a lot more choice in it than I do. I remember being able to ‘invoke’ it when I had ‘bad thoughts’ or felt overwhelmed as a teenager or maybe younger. Now it seems to be here pretty much all the time and I can’t make it go away. I don’t think she really understands what depersonalisation is or at least how it affects me.
One of my pieces of homework was to fill in the YSQ-L3 questionnaire. This is the Young Schema Questionnaire long version – all 205 questions. I left it to the last minute as per usual. I have got to stop leaving homework to the last minute. Anyway, it identifies schemas. Schemas are the same as core beliefs and Young et al define them as “broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.” B scored my answers and my two main schemas are the defectiveness schema (“there’s something wrong with me”) and the social isolation schema (“I don’t fit in”). I definitely agree with both. I was pretty aware of the defectiveness schema stuff in my head but I was really struck by how the social isolation schema resonated with me. I didn’t fit in at home because I wasn’t really part of the family (what?? adopted, yes, but … this is really vague yet firm in my mind), I didn’t fit in at school either in primary or secondary and then when I dropped out of medical school I didn’t fit in with my friends or anyone really. The only time I fitted in was when I was a medical student and that got taken away from me by this stupid fucker of an illness. That’s a big part of why dropping out of medical school hit me so hard and made me fall apart – I was a nothing again. There are other schemas too and some also partially fit me.
B gave me a copy of her formulation in one of these early appointments which I really appreciated. I remember saying to her I felt “very attached to these pieces of paper”. I was only partially joking. In psychobabble terms I feel very validated by her formulation.