Outpatient Fail

All of our therapy is outpatient. We see our therapist in their office every two weeks. We talk. They push us to talk about the things we’re obviously avoiding. Mostly it works. Until it doesn’t.

That was this week. This week therapy turned to shit. Shit. Complete and utter shit.

I’ve written about our excellent ability to zone out before. It doesn’t tend to end well.

Often it happens during therapy sessions. We’ll be discussing something and become emotionally overwhelmed. Often I feel incredibly anxious, sometimes sad or scared, but whatever the emotion – very overwhelmed.

By this point the conversation will stall. My responses become slower, my voice quieter, and I say ‘I don’t know’ repeatedly. I’ve already stepped back from my body without actually choosing to. At this point there’s nothing anyone can do to help me become more responsive.

Usually I’ll be asked to move by whoever I’m with (psychologist, psychiatrist, nurse) and be unable to. My body is frozen, and although I can hear and feel (and see if my eyes are open) I can’t move. Eventually my head tips to the side, the weight of it seeming to drag it towards my shoulder. From there my body can slowly slide sideways, and if I’m in a chair, out of the chair and on to the floor.

This time wasn’t that different. It’s just that this time was the first time this therapist had to manage it outpatient. They’ve dealt with it repeatedly in an inpatient setting. That’s much less dramatic. They let the nursing staff know what’s going on so I can be monitored, but generally leave me alone to come out of that state at my own pace.

Outpatient though? It’s a downright disaster. I couldn’t be moved. My therapist had other clients to see, but had to reschedule at least two of them. Eventually they had no choice but to call an ambulance to take me to the local hospital emergency department.

That’s when it got worse. I was unfortunate enough to get two male paramedics. Ordinarily that wouldn’t bother me. In such a dissociated state they were terrifying. They were men. Men are bad. Men are not safe.

To make it worse they repeatedly inflicted pain to check my level of consciousness. They did this four times with minimal response from me. Meanwhile I could feel all the pain, but wasn’t able to properly respond. The most they got was a mild grimace, yet they continued. Being conscious, but unable to move or talk is not fun. Throw in pain being repeatedly inflicted and it’s terrifying.

After being released from the emergency department I went home, crawled into bed, and slept. The following day was time to face the music. One super brief phone call from my therapist later, and we’ve planned a hospital admission for August.

August. The month where I had multiple medical appointments. The month where I was finally going to get my pesky wisdom tooth (last one!) removed. Everything has to be rescheduled.

It feels like defeat. Complete and utter defeat.

I can’t safely manage outpatient therapy. I have two more appointments booked with my therapist, but I’m not sure if I’ll go. I’m scared after this week. Scared that I’ll zone out again.

I did have a few thing against me this week. I’d overdosed (wishful suicide attempt) the day before and had a huge hangover from the medication I’d taken. I was rejected for the NDIS for my physical health issues. An outreach worker told me they’d be moving on, and someone else would be taking over my care. Then throw in a trauma anniversary, and the unrelenting depression that’s been haunting me for a year. All of that, even on a good day, is a bad combination.

Trying to stay present with all of that going on is next to impossible. Add in an emotional conversation with my therapist, and I don’t think I had any chance.

Anyhow, hospital it is. Hospital because outpatient therapy is a fail. Again.

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Pancake Days

A few weeks ago Miss 5 was insistent that we have pancakes for lunch. Having the sweet tooth that she does they were served covered in copious amounts of maple syrup. After devouring them (and more sugar than we ever needed!) she watched Sesame Street on TV.

When Sesame Street finished Miss 5 disappeared back inside, and Miss 7 came out to watch the show that was on next. Miss 7 stuck around for several different kids shows, then also disappeared back inside. Then Miss 3C came out and quietly watched another TV show.

In between all the TV watching that was going on different parts wrote in our journal. Lots of conversation was had, and a few issues raised to discuss in therapy. It turned out to be an incredibly productive afternoon.

Given how helpful it was, we tried it again a week or so later. This time Miss 7 got to help with making the pancakes, and thankfully, there was less maple syrup involved! Then, as with the week before, there were more kids TV shows, lots of journalling, and talking inside.

Now we’re waiting for groceries to be delivered so we have the ingredients to make more pancakes. This time Miss 21 is going to be making the pancakes. Before she starts cooking  I’ll get out our journal, pens, pencils, and other art supplies. Then, once we’ve eaten, anything goes.

Allowing time for everyone to come out has been really helpful. There aren’t any rules aside from keeping the body safe, and not leaving the house. Older parts, myself included, are always around to help out if need be. Younger parts can play with their toys, draw, watch TV, or write with help from others.

The other part we’ve had to be careful of is making sure we’re home alone. We have a lovely housemate, but they don’t know the extent of our mental health issues. We’ve mentioned depression and anxiety to them, but nothing about trauma, dissociation, or DID. These pancake afternoons are very carefully planned to make sure we’re alone, and won’t be interrupted.

Will Therapy Ever End?

Our current therapist made a comment recently that made my heart sink. They said they thought we’re likely to need, at least, some supportive counselling for the rest of our lives.

The body is in it’s early thirties. If we make it to even eighty, that’s another fifty or so years of therapy. Maybe not weekly like now, but perhaps monthly.

Our current therapist will also be retiring in the near future. We’re trying not to worry too much about that, and trying to focus on getting as much DID focussed work done as possible in the time we have left.

That’s one of the hardest parts about having DID. Finding a therapist who has enough knowledge and experience to actually be helpful to us. In the last eight years we’ve just been lucky to come across therapists who are excellent at working with trauma and dissociation.

We’ve recently spent several weeks in hospital. None of us regret the admission. We got a lot of work done, and nearly all of us were able to talk to our therapist. No easy feat when there’s eighteen of us!

Our therapist is confident that we’ll have the majority of our trauma and DID based work done before they retire. I’m not sure how realistic that is. As much as ongoing therapy (for the rest of my life) makes my heart sink, I also can’t imagine our life without regular therapy or hospital admissions.

Does therapy ever end when you’ve experienced chronic childhood trauma?

The Stigma Of Treatment

All the important people in my life know I struggle with my mental health. That’s old news. I’m not even overly anxious about sharing some of my struggles with the right people at the right time.

On the other hand sharing what treatment I’m receiving for my mental health is so much more anxiety provoking and worrisome.

I’m on three psychotropic drugs, and there’s plenty of judgement and stigma from people about that. I need these medications to function, if anyone has a problem with that, they can get lost.

I’m seeing a therapist weekly. At this point in time the therapist is a psychiatrist. In the past they’ve been psychologists, clinical psychologists, and counsellors. Therapy is a really good way to help me manage my mental health. Again, if people have a problem with that, they can get lost.

Then there’s the inpatient psychiatric admissions. Five in the last two years. Most of them for about three weeks. Not all in times of crisis, but of great stress, and with multiple crappy coping strategies being used.

I’m heading for my seventh admission with the same doctor at the same hospital. I trust my doctor, and I trust the nursing staff. I know the admission will be helpful, they always are, but I’m scared to tell anyone.

I worry so much more about what people might think about me being in a psychiatric hospital, than being on medication, or in therapy.

Is it really that bad that I need to be in hospital?
Yes. Doing the same amount of work in therapy outpatient is impossible. Plus I’m stuck, again. DID chaos, and multiple shit storms brewing beneath the surface. That doesn’t even cover the issues I’ve had with mood (both hypomania and depression in the last month). It is that bad.

Can’t I just get over it? Isn’t therapy enough? Can’t they give you medication?
I’m doing the therapy, and taking the meds. I’m still struggling. As for getting over it? Get lost.

I know hospital is a safe place to crash land. I can be a mess, be emotional, struggle in any kind of way and it’s okay. I don’t have to keep it together. I don’t have to keep smiling. Staff are kind and supportive. I have time and space to unleash the chaos, work through it, and put myself back together again.

I’ve still only told a few people. I’m so fearful of their reaction to, and judgement of inpatient treatment that I stay silent.

I think the stigma associated with psychiatric or psychological treatment can often be so much worse than the stigma associated with a diagnosis.

It’s okay to not be okay, and it’s even more okay to get whatever help you need to be okay again.

Stuck

I’ve reached a point that I’ve reached many times in the past. A point where outpatient therapy isn’t working. A point where I’m fleeing the images I’m continually seeing in my head, the nightmares, the body memories.

Therapy involves talking. Talking about the flashbacks, the body memories, the terror, the fear, the anxiety. It means facing what I’m scared of and trusting my therapist to go there with me.

At the moment I’m running from all of that. Listening to what younger parts have to tell me seems okay in the moment, but it allows everything else to come up. Once that door is opened it’s very hard to close.

Talking about that in therapy leaves me sitting in an awkward silence. Too scared to talk about what’s really going on, but still frustrated at my fear.

Opening up that cupboard of painful, traumatic memories leaves me feeling overwhelmed. When that emotion reaches a tipping point I zone out. Dissociate to the point of being completely unresponsive. So unresponsive that I’ve been referred to as unconscious whilst in that state.

That unique ability makes outpatient therapy difficult. I’m desperate to talk about everything going on inside, but terrified of not coping, of losing control, of zoning out. Dissociating at the moment, to that extent, is almost guaranteed if either I or my therapist push talking.

That leaves me with only one choice. Another hospital admission. I’m frustrated and angry at it coming to this point again. I don’t want to be in hospital. I want to be okay. I’d prefer to stay at home in my own space, with my own things, and my freedom. Sure, hospital isn’t bad. It’s actually one of the most helpful things I could do right now, and the staff are amazing, but I still don’t want to do it.

I have a month or so until my admission. A month or so to try to get practical things organised for the time I’m in hospital.

Depending on how I cope in the lead up to this admission there may or may not be new posts. I’ll try to keep up with posting every two weeks, but prioritising self-care means this may not happen.