Appointment with clinical psychologist

This post is dated the day I had the appointment but I’m writing it over a week later. Again. :-( I will try harder. My memory of the appointment is definitely not as good as I’d like. I do remember that she complimented my green skirt.

B said that as we had agreed in the last appointment this appointment was going to be about eating. She then asked me how I had been over the last week. I said my mood had been up and down but that I was have more and more problems with my parents. I just do not want to have anything to do with them. I haven’t really spoken to my father since last summer and I haven’t seen him except for his very brief visit last September when D moved to B and my brief visit to F last month. I am also much more distant with my mother and phone her as little as possible. Partly that is due to the fact that I think she’s handled her problems at work badly and made things a lot worse for herself and partly I am still really angry that she didn’t take me seriously when I told her about my eating disorder and said that I “wasn’t a real manic depressive”. Those two conversations were ages ago and I still resent what she said. My anger at both of them is got a lot worse after I got the formulation from the psychologist. When B asked me in the appointment why I was angry with them I only talked about how I felt after I got the formulation. I made excuses for my father, blaming his lack of understanding and support on his upbringing though I’m not so sure about that now. There’s some kind of vague “he didn’t sign on for that [mental illness]” thought in my mind but that’s crap. If you adopt a child – which he did including the whole legal process – then you take on everything just like if that child was your genetic child. But about my mother, I said to B “why didn’t she notice?” though again I prefaced it with excuses for her. When I was saying that the depersonalisation broke down for a moment. I was really there, in that room and in that moment. Then it sprung back up. It made me think that the psychologist’s interpretation of the depersonalisation as a detachment from painful emotions is more likely to be true than my idea that it is some purely biochemical anomaly in my brain which the quetiapine had fixed. B said she thought it was healthy and understandable that I was angry and encouraged me to talk about it.

We briefly talked about thought diaries. As the one that I had the most problems with was after binging (I’d forgotten about that mini-binge) we didn’t talk about it in detail as we were going to talk about disordered eating later on. I got the impression the I am to keep doing thought diaries as she said the aim is to “build a case against the schemas”. I’m not sure how many she expects a week. I should ask about that.

Then we started talking about healthy eating and disordered eating sympoms. I got the impression that she had done her homework in preparation for this appointment! Also she definitely paid attention to what I said in the last appointment as she repeated some of the things I had said (about fasting after binging). She gave me a photocopied book chapter about healthy eating to read with parts highlighted that she thought were particularly important. A suggested some healthy eating mantras (perhaps she’s heard of the ana and mia ones?):

  • Eating healthily allows me to fuel my body with good, nutritious food which demonstrates my respect for myself.
  • Eating healthy food on a regular basis will help my mood by keeping hunger away and my blood sugar levels stable.
  • I deserve to look after myself with healthy food.
  • Overeating and starving myself maintains my mood difficulties and gives in to my defectiveness schema.
  • Overeating adds to my unhappiness about my weight.
  • Every time I give the binge-fast vicious cycle power it takes away my power (this one is mine).
  • Don’t think about it, just do it!
  • You are not good/bad depending on what you eat.
  • Remember food is just food, not to be feared or revered.

We filled in (I wrote) a sheet about coping strategies for triggers for binging. The biggest trigger for me I think is seeing what I consider binge food. Even pictures of it, though that is less strong. The worst is seeing it in a supermarket particularly fucking M&S. I can easily buy it and there is loads of it. I just looked through the first five pages of a google images search and I could feel the binge urge coming. I didn’t actually say this in the appointment and I should. It kind of falls under stimulus control which she did talk about but I also need to have a plan about what to do when I come across pictures or food unexpectedly or when shopping. The coping strategies we did talk about were:

  • talk or write to someone
  • write in this journal
  • allow the emotions out by crying (perhaps helping them with music) but be careful to avoid dwelling on them
  • cuddle the rats
  • read Paul Gilbert’s book Overcoming Depression
  • fill in a thought diary
  • relaxation exercises
  • listen to music
  • pick one thing from my to-do list and concentrate exclusively on that until it’s done
  • have a healthy snack e.g. V8, fruit

My homework is to read the photocopied book chapter, make a meal plan and do the food diary.

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