“Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner.
Psychotherapy aims to increase the individual’s sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of a client” – Wikipedia
In my experience, most mental health centres and hospitals look the same. Red-brick buildings with NHS-standard signs directing patients to different departments, a row or two of (usually blue) chairs in a soulless waiting room, and old copies of Lancashire Life stacked on a low table if you’re lucky. Mazes of corridors and doors which are always kept locked. A buzzer or bell to gain entry or allow exit. Sometimes the paint on the walls differs, but it’s usually a palette of beige, pastel green or pastel yellow. “Calming” colours.
They inevitably make me think of the contents of an unwell baby’s nappy.
Our local mental health centre is, handily, in my town. It was recently refurbished and is now very different from the brief glimpses I got when I was being hauled – twice – to a private room on suicide watch in my teens. Back then the entrance led to a huge staircase which dominated the entire hallway of what used to be a beautiful old building but which has now been added to so much that it’s lost most of its character. Now, the staircase has been remodeled and everything’s been painted an off-white. There’s lots of glass and bright posters. It almost feels like a primary school, except you’re always aware that there are people upstairs, being watched 24 hours a day in case they hurt themselves.
I sat with my mother, and waited. As my legal appointee, she has a right to accompany me to any appointments and while I usually try to wriggle out of it… sometimes I need her. My fear of going back into the mental health system after over a decade of let-downs and damage inevitably took over, and I know I wouldn’t have coped on my own. As it was, I had a small panic attack when I realised the psychiatrist was stuck in traffic and would be late; if I ever needed control, it’s when I’m about to open up my fucked-up heart to a complete stranger.
I was mildly surprised that the psychiatrist I saw was a young woman. I’ve become used to stuffy old men in shirt and tie, peering at me over their glasses and shrugging off all my concerns as being “down to my age”.
Another blue chair. Another desk, another patient file. I’ve done this so many times that I may as well just record what’s said and play it at the inevitable next appointment a few years later. You see, I have a problem sticking with things, and I’ve already spoken about how I find it almost impossible to be honest when faced with authority. When everything becomes too much I cave in and accept professional help, but I either pretend nothing’s wrong, or never go back. It’s as though I want to help myself, but the process is too frightening. Therapy means a loss of control and a need to be painfully honest; two things I find almost impossible to deal with.
I explained to the psychiatrist that I felt I was too old to still be dealing with all this, and that the mental health system has let me down a lot in the past. Picked at my jeans and stared at the wall as I detailed everything; the panic attacks, obsessions, paranoia, the total lack of self-esteem, the drugs, the painkiller addiction, the times in my teens when I relied on stolen bottles of gin to get me through the night, the self-harm, the bulimia. As I spoke, I realised that honesty was never going to come easy; although I was forcing the words out with all my strength, I still held back. However, my stumbling confessions were enough to confirm the diagnosis of BPD, and to earn me a referral for psychotherapy.
Specifically, I’m on the 18-week waiting list for CAT Therapy.
Cognitive Analytic Therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK’s National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.
The CAT practitioner aims to work with the patient to identify procedural sequences; chains of events, thoughts, emotions and motivations that explain how a target problem (for example self-harm) is established and maintained. In addition to the procedural sequence model, a second distinguishing feature of CAT is the use of reciprocal roles (RRs). These identify problems as occurring between people and not within the patient. RRs may be set up in early life and then be replayed in later life; for example someone who as a child felt neglected by parents perceived as abandoning might be vulnerable to feelings of abandonment in later life (or indeed neglect themselves).
It all sounds like much of a muchness, and initially I was reluctant to even consider it. Most experiences I read online leaned very much towards the negative, and the idea of writing a “goodbye” letter to my therapist is an odd one; I usually leave therapy sessions by simply walking out and never coming back.
However, I’ve given it a lot of consideration over the past few days. Knowing CAT is a “cheap” therapy is a concern; does that make me a snob? I’ve decided that a minimum of eighteen weeks is a long time to think it through, and I do have the safety net of being able to leave whenever I want; I’m not being forced into psychotherapy. It’s my choice, and I think at least giving it a go is the right decision.
- Choose Psychotherapy: Another Treatment Option (yourmindyourbody.org)
- Letters: Cut-price therapy and the trauma underlying mental ill health (guardian.co.uk)
- Would you like some psychotherapy with your Weetos? (beamagazine.wordpress.com)
- DSM-IV: Depression Defined (everydayhealth.com)