Tuesday, 1 September 2015

Finishing therapy

I looked back to refer to other blog posts about the CBT I have been having and found none, realising that I had not written anything about it since I started in mid June.

I wrote back in April in my post Mind Matters about how I had referred myself to the local mental health team and it was decided that I had PTSD in a mild way due to a traumatic incident during my transitioning. The aftermath of the incident was that it had led to anxious and worrying tendencies and it was hopeful that a short course of cognitive behavioural therapy (CBT) would help me deal with these issues.

I started back in mid June and my therapist discussed my issues in depth. My main two behaviours that were causing me the most problems were negative rumination (regurgitation and reliving of past memories in a negative way) and catastrophisation (always thinking the worst it going to happen). This process of therapy requires a level of self-criticism and it is not easy to admit that you have these problems. I was determined though and accepted this was where I was going wrong. We talked about how I worried about things and whether these worries were practical or hypothetical. Practical worry solutions relied heavily on making plans to solve them because those worries often stemmed from real problems which could be fixed. Hypothetical worries were different to deal with because they were often non-existent in reality; they were often about things that had yet to happen. Typically, hypothetical worries were my problem and I was told that hypothetical worriers rarely have practical worries because they often find problem solving very easy.

It initially relied heavily on homework which was mainly in the form of keeping a diary, a worry diary to be exact. Every time I found myself worried or anxious, I had to write it down along with a classification of hypothetical or practical and a score of 1-10 in severity. I did this for a fortnight and we examined what was going on. I do not think there was a single practical worry in any of it. I also had had a few very busy days in that fortnight and worrying was very low on those days. It seemed I was worrying more when I was less busy, when my mind had more time to wander.

We moved on to dealing with the worries and this was done with the aid of "worry time". I was to write down my worries and then put them to one side. At a certain time of the day, I would go somewhere quiet and worry about them for a set period of time. The theory sounded good but I did not actually pursue this part of the treatment. 

I seemed to enter a new phase of my life at around this point. A few things had clicked into place outside of all of this, my mind seemed to slowly settling down properly since my surgery and I was starting to really enjoy my new-found voluntary work. My past trauma that had caused all of these issues seemed much less important and I finally felt for the first time that I could let go of it. I returned to my next session, explained all of this and how I was feeling. My therapist decided I had made progress although not in the conventional sense. I was given some other guidance, relaxation tips and pointers on mindfulness and asked to return in a fortnight to see how things had been going. If the anxiety did return, then try the exercises.

The anxiety did not return and I was starting to move to an even more comfortable place in my mind. When I returned, we discussed it all in depth and decided that we would wait for six weeks and if I did not relapse, then we would discharge me.

The very next day saw me attacked in a hate motivated incident. This had the potential to completely derail everything we had achieved and it did lead to a few weeks of extremely low mood. I did draw on everything I had learned and discussed and found myself slipping back into old ways a few times but always managing to realise what I was doing and correct it. When I wrote about the aftermath of the attack, I discovered as I was writing, that I was going down dark paths and actually describing what might have happened had things been different. When the physical element of the attack was described, I started proposing how I could have been seriously hurt. I quickly realised as I was doing this that I was catastrophising and stopped myself. I went back and deleted everything I had written that was not fact.

In the end I picked myself up from this attack and moved on from the whole affair. The closure I had last week helped and today saw me visit my therapist for the final time. I showed her my scores on my test sheets (a series of questions to quantify mental health) and mentioned that I had Mandy verify them because they seemed so good. We talked about the attack, how I had picked up on the catastrophisation and generally how I got through the event. We talked about my past trauma and that I felt I was ready to let all that go now. I told her how I have found myself much better at reflection and know the difference between that and rumination.

We also talked about my work, what it was doing for me and how I was making serious plans for my future, possibly in a similar line of work that she did herself. Was I ready for discharge? We both felt it was definitely time and with a shake of the hands, we parted company with a proposition that we might meet in a different capacity in the future. That would be very satisfying indeed.

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