This is post is dated on the day I had the appointment but I’m writing it over a week later. Not ideal but at least I’m writing it at all. The appointment was okay but I didn’t feel the same relief and progress that I did the previous week. I also didn’t feel that I connnected with the psychologist, B, like I did the previous week and that she picked up on that too. I feel like I did something wrong.
First of all she gave me a copy of her letter to my consultant Dr S. Later on, I asked I to read it and he was sympathetic and sweet to me which was really nice. I feel quite a mixture of things when I read the letter. There’s relief that someone, especially someone knowledgable and experienced, says I do have real problems and it isn’t just me over-reacting or being pathetic. But then I’m frightened too by that as it means there really is a problem. In particular, the formulation (seems to be the equivalent of a diagnosis but in the clinical psychology model of things) of me was kind of painful to read. Here it is:
[Her] early experiences led her to believe that she was worthless and unlikeable. In contrast, her strong academic performance meant she was often praised and rewarded for her school work. Subsequently [she] learned that she was ony worthy if she was achieving. This belief pushes [her] to seek perfectionism in all that she does for fear of failure and rejection. However, she frequently overcompensates, pushes herself too hard with the consequence that she is unable to reach her own standards. This in turn reaffirms her negative belief that she is worthless and precipitates depression.
[Her] perfectionism compromised her ability to study effectively whilst at University as she constantly found herself ruminating and procrastinating over her work. She also used maladaptive strategies such as emotionally detaching from others (depersonalisation) and overspending, as a way of compensating for feelings of worthlessness. These compromised her mental health and contributed to her fluctuating mood states. [She] remains vulnerable to fluctuating mood states as she continues to seek perfectionism in all that she does and to query her self worth.
Also from this letter “Schema therapy is a systematic approach that expands on cognitive behavioural therapy by placing greater emphasis on exploring childhood origins of psychological problems and on maladaptive coping styles.”
Whilst I wanted I to read this letter the thought of my mother or father reading it makes me feel really guilty. I think my mother would like to read it but it isn’t going to happen.
Then B described a plan for the appointment. She asked me how I had been over the last week and I told her about restricting (I keep wanting to put that in inverted commas because of course someone this FUCKING FAT can’t be really restricting but then again, less than 800 calories a day is restricting … round and round we go) and the cravings for binging. Thinking back, I was probably censuring myself a lot which I know she doesn’t appreciate. I feel stupid, self-conscious and like any second she’s going to start laughing at me so it’s hard to be frank with my words. She asked me if I purged and when I said no I really got the feeling that she categorised me as ‘not-so-serious’. My old CPN D said I was an atypical (or type 2) non-purging bulimic. I wish that I purged because it would make my life a lot simpler (I know that makes me a cretin). Anyway, B asked if I wanted to be referred to a dietician but I said no. We agreed that we would devote an appointment in the future to these symptoms. All this took up a lot of time and I felt bad that I had used up this time that we should have been spending on psychotherapy.
Next we looked over the thought forms that I had done. Three out of the five were about body image or eating symptoms (I need a better name for them). That kind of made me feel bad like I’m supposed to be there to deal with depression not eating symptoms. Also I don’t know if five thought forms were enough. B didn’t praise me as much as she did the previous week and that worried me. I wonder though if I’m hoping for praise because that always seems to be a cure-all and soothes everything for me. So, in psychobabble terms ( ;-), that says more about me than it does about her opinion of my thought forms.
Homework is to read chapters 1-4 of Reinventing Your Life by Jeffrey Young and Janet Klosko and to do more thought forms.