Things I wish I knew about therapy

Today I kick off a series ‘Things I wish I knew about’, and we begin with what I wish I had known about therapy.

I make no secret about my wellbeing, I’ve lived with anxiety and obsessive compulsive disorder since 2009. It’s been a rollercoaster, in some moments I feel light and rational while other days I am consumed by the worst case scenarios that may or may not happen. Through school, I had constructive relationships with mental health support staff they provided me with the space to offload and feel heard. I was reluctant to access NHS or private therapy thinking it would be shameful for doing so, anyone who was a teen in 2009 can remember the representation of mental health on TV; Jean and Stacey Slater living with bipolar disorder in EastEnders and Ruth Winters living with depression and bipolar disorder in Casualty.

I have been in therapy for four years, privately and NHS funded. In the last four years, I’ve had many people around me ask lots of questions which come from a place of ignorance. I use ‘ignorance’ lightly because when we don’t know the answers to our questions, we have a habit of asking a question from a place that comes out ignorantly.

In this piece, we explore some of the things I’ve learnt in therapy and I’m going to share them so we can reframe our questions for prospect therapy patients.

Progress isn’t linear

There has been a 21.5% rise in the number of people accessing talking therapies for their mental health; from traditional counselling to cognitive behavioural therapy (CBT).

For many patients, they will access a talking therapy via their GP which holds a very long wait, an area under-resourced and funded, with 1.4m on a waiting list. To put it into perspective, I requested CBT in the November of 2017 and began the sessions in June 2018. I also requested CBT in May 2021 and this didn’t turn up until June 2018. In that time, the reason for the referrals were no longer taking up as much mental space as they previously had. It’s a shame the NHS continue to sign-post newly diagnosed ME/MS/ EDS patients down the CBT route; no thought challenging will reduce pain, believe me.

With most patients being allocated a 6-12 week block of NHS funded therapy, there’s no wonder why hundreds of us find ourselves baffled that we are not on a linear upward ride with our therapists. The reality is, I go through periods where I’m making amazing progress and staggered by the progress but there have been times where it’s felt intense and really difficult. Life isn’t linear, we all experience intense heartbreak, trauma and grief three things which are horrible to manage. So, if our live has many downs why are we expecting our therapy to be follow an unrealistic journey?

You do you

I’ve had a couple of GP mental health referrals for CBT in the last six years, and in that time I made immediate progress but struggled to notice real long term sustainable improvement to my thought processes. CBT helped my OCD, but it never allowed me to understand where that came from because I was allocated 6 30 minute sessions. One of which was a terms and conditions and another was the end of treatment recap. So, 4 sessions are supposed given, we could argue the sessions mimic a plaster being put on an amputee wound.

As I went into my second year of private therapy, I began to wonder if it was normal and whether I was failing because everyone around me were ‘fixed’ after their NHS block. I had various conversations with friends and family who told me to cut ties and move on; but like we said earlier, if you have the belief that you will be fixed in 6 sessions you might be disappointed. I learnt in a candid therapy session, the number of yo-yo patients, NHS CBT blocks acting like conveyor belts.

I had to sit with the belief, that if that 50 minute session benefitted me than it shouldn’t matter to anyone else. If it’s benefitting you and your needs, then that is all that matters. It’s a shame this belief I have towards therapy I can sit with, but other choices I find deeply distressing and challenging.

Mystery about the person

I’ve known my private therapist for four years, I rock up to her clinic for 50 minutes. I leave that session. I wonder, what she might be having for dinner? What book she’s reading? How her marriage is? Does she like cheese? What’s her favourite colour? The reality is, in most legal and compliant therapists should not engage with you outside of that appointment; you can of course email about a pending session or payments etc but I don’t message my therapist with ‘hey did you watch X on?’ and I know if we crossed paths in a supermarket, we would glide past each other without a wave or introduction.

Sitcoms and films are not accurate

If we went based on what we see in the media as our insight into therapy spaces, we’d be thinking our therapist would knock on our front doors, offering tea and cake. I remember at my very first private therapy appointment I asked where the sofa was and why a cat wasn’t sat on her lap while I sobbed. I was also shocked to learn that a therapist shouldn’t be telling you what to do; in frequent depictions of therapeutic relationships you’ll hear and see the protagonist saying ‘my therapist told me to say and do this’. In the conversations I have with my therapist, we unpick the challenges I present and we discuss them and 9/10 I reach a natural conclusion myself by the end of the appointment. You should see your therapist as a city tour guide; they’ll take you round and give you some city navigation tips but you need to go a bit deeper yourself to find the hidden secrets and the good food spots.

The therapeutic relationship is one of few things in my life that I don’t question nor ponder, I accept that the 50 minutes I have with my therapist as pivotal for my own wellbeing and is the self-care that goes beyond baths, face masks and manicures.

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