Yesterday I had my meeting with the head of the DBT programme, a lady, D. This was to discuss my future in treatment now I was refusing to work with M (with good reason: My Last Appointment).
D immediately put me at ease and cut to the chase – what were my options?
- Leave DBT, the only treatment and support I have.
- Suspend DBT until an alternative therapist becomes available (predicted 7 months away) leaving me with nothing in the meantime.
- Continue DBT with M as my one-to-one therapist.
Not an appealing whole bunch of choices but that’s the situation. This is the overstretched NHS. There just isn’t another therapist available. It’s a strange thing though as I asked to continue attending my weekly DBT group which would also give me access to the dedicated helpline but that was refused. The argument given was that I could not continue in DBT without the one-to-one appointments for my own safety, because of my life threatening behaviours. Damn. It didn’t occur to me at the time but it does seem a bit odd that they would rather leave me with nothing rather than provide a limited service, given that I have life threatening behaviours…but they have their rules and there are reasons for those rules that are much bigger than my own individual situation. I told her that this felt punitive to me. I had done absolutely everything asked of me and have approached this whole process in good faith, to have it taken away when I’ve done nothing wrong just seems so unfair (predictably unfair). She said it wasn’t punitive. I said I knew that but that was how it felt. It also made me angry. Hello radical acceptance!
Hmmmm. We then spent the next hour discussing how I had found myself in this situation. It was good conversation: open, honest and on my level (I can feel quite patronised by health professionals). I felt that D succinctly got to the core of the problem: in my sessions with M I had not been validated. Her approach had wandered more into other therapies. However, in DBT the approach is to validate and change. So I was turning up every week, working my socks off and never feeling like I could do anything right, constantly criticised and just worn down. M always had this saying “In DBT we say we acknowledge you’re working hard but think you can always work harder”. I explained to D that I just didn’t think this was the case – sometimes I can’t work harder! I really, really can’t! And she agreed. She told me that that particular phrase comes with the caveat unless change is happening. So, no, I couldn’t work harder because change was occurring and I have been regularly applying the skills I learn in group. I didn’t know if she was playing along or if her some of her shock and concern was genuine. It felt genuine and I’m pretty good at telling. After we had discussed why I no longer wanted to work with M she seemed to really get it and, in fact, this meant that I really was in a tricky situation.
D told me that M had to make a repair to me. I started to cry because I didn’t want to upset M and I’m really sorry that all of this has happened. I didn’t mean to hurt anyone. D gently reassured me that she could see that. I said I was happy for M to make a repair to me because I knew M would be feeling bad about what happened and I didn’t want her to feel bad. D told me that the reason M was to make a repair to me was because I deserved a repair. I was uncomfortable with that so I’ve to do radical acceptance work on that. I’ve also to do a cope ahead plan for the repair meeting. I’m dreading it.
The final piece in the puzzle was what I bring to the relationship and there is a problem with that. M has to try and read me in our appointments but yet I am extraordinarily difficult to read. To be fair I often don’t process challenging information immediately. Instead I take it in, file it and then, when I get a chance (when it’s safe), I have a look at it – that’s when the emotions generally come. So in my last appointment with M I outwardly appeared fine. I laughed and held conversation and reacted appropriately because that’s what I do. This makes it really hard for the therapist and leads to another problem. It may be that M feels unable to continue with me because her own confidence is so dented that her self-doubt would really get in the way. I get that. It’s not good though.
It’s unsurprising of course because it’s what always happens. I try and believe that it will be different but deep down I know it’s only a matter of time before anyone who tries to help gets taken away from me. I reckon M will say she can’t work with me anymore and then? Well, here I am. Just me and my life threatening behaviours for company, because they never leave.