This week I had a virtual psychology appointment as I had my surgery on the day my session normally takes place, it was helpful to have a session even if it was via telephone. I know that without utilising modern technology I wouldn’t have been able to have a session at all I really wasn’t fit to travel or sit normally. This led me to think if any of this would be possible on the NHS and of course I know that it most probably wouldn’t be, the NHS isn’t able to be as flexible.
I am fortunate that currently the NHS fund my psychology under mental health act regulations and due to a lack of provision in my Clinical Commissioning Group (CCG) area, they fund me to see a psychologist from a neighbouring CCG as if a private client.
The professional I see works in both the NHS and the private sector and they are extremely knowledgable of Dissociative Disorders and trauma which is exactly the skill set I required.
Prior to this we received our treatment in various ways, some private sector and some NHS, I can recall my psychological treatment within the confines of the NHS as well as the private sector units we were forced to reside in, I thought it might be useful to share some of these experiences with you.
I can so recall my first encounter with psychology when I was a child it was very different from today, I was 12 and I had been referred by a paediatrician. This man ran his clinic in association with a social worker who I always felt was going to come and lock me up, especially when my mother would lay the blame for difficulties on my behaviour. The truth was of course that I was being abused at the time, I was in total internal crisis stressed beyond belief and desperate for stability and security. My Mother blamed me in order to divert attention from herself and at the time I was so brain washed into believing everything was my fault, that I feared my appointments with this doctor and the social worker.
The psychologist saw me on a regular basis in a small first floor room, my mother would sit in on the majority of these sessions and would often see him alone before I joined the appointment. There was never an opportunity for me to tell how I felt, or the chaos in my life as I was too afraid to speak in front of my Mother. Having read my medical notes from this time I now know the doctor understood my issues were due to a difficult home life, he even labelled my Mother. I know today if that happened there would be child protection panels etc, but in the 70’s and 80’s no one took any action to protect us they just wrote their note and gave us medication to hep us cope. These sessions were not time limited in the sense of the number of sessions available, you saw the doctor until he decided you didn’t require his help anymore.this is a far cry from today.
As an adult in the 1980’s and early 1990’s I did get access to psychological services, often there were short waiting times and interventions were not meant to be long term. This was just a place to go and talk rather than move forwards, well that’s how I perceived it at the time. I cannot imagine short waiting times today, they definitely seem a thing of the past.
Some years later shortly after my first admission I was told I needed to have talking therapy, the psychiatrist was honest he informed me that if I waited on the NHS I’d be waiting for many months, so he actually recommended someone privately. Despite it stretching us financially my then husband and I funded my sessions, I found them difficult and bewildering, I wasn’t in a good place mentally and 45 minutes a week seemed too little. The sessions were disjointed from the rest of my care, I had started seeing this particular counsellor whilst in hospital and yet there was no dialogue between her and the hospital or vice versa. I was home a few days and then returned to hospital, it was clear I wasn’t making improvements, just spiralling downwards, so the sessions didn’t last long as it was clear it wasn’t the right solution at the time.
I then joined the NHS waiting list, this took some months but nothing like as long as today’s waiting lists before I was eventually given CBT. The session were even allowed to continue during my hospital admissions and there was a dialogue between the psychologist and the rest of the medical team. I didn’t realise how unusual this was until a few years later but I realise now that this joined up working between psychology and psychiatry is not the norm.
My CBT was time limited and I was not included in the planning of my treatment so it all felt very one sided and a bit like a them and us situation. I didn’t feel I had any ownership of my treatment, just a passive participant who attended and was talked to sadly, rather than a willing equal partner in my sessions.
When at another locality I was allocated a member of the psychology team I was surprised to find myself treated as a equal partner in my care, yet I was stunned at the lack of partnership between psychology and psychiatry. When I was admitted to hospital and the psychology team wanted to continue our sessions, it seemed incredulous to the ward staff that a psychology team member wanted to use one of the breakout rooms. It was a battle just to get the ward to facilitate a room for my sessions, that included having to challenge ideology that was entrenched in people’s minds. The psychiatric team seemed impossible and very unwilling to allow a psychological perspective into my care, they would make it so difficult to hold the sessions and put so many obstacles in our way. So much for a joined up perspective in mental health it certainly didn’t exist in that place and it hinder my progress and my care.
In the privately run secure units, psychology was available but it wasn’t an equal partnership, the sessions were mandatory and the ones I had were held in a room I couldn’t really leave, everything was dependent upon them. If my therapist felt I wasn’t actively engaging or perhaps didn’t like my responses they had the power to take away privileges, be that access to my room, or being allowed unescorted grounds leave. I once was said I felt nervous outside, frightened of a past abuser and that I was pleased to be working through this one step at a time on my unescorted grounds leave, the next thing I knew they had stopped my unescorted grounds leave. There wasn’t any discussion or debate it was just a big stick approach, they held the power and I had none.
I used to dread my sessions for fear of saying or doing the wrong thing, because I knew that she had the power to make my days in that unit a thousand times worse. It wasn’t about improving my psychological well being, but about wanting me to understand I was now controlled by the staff in that place. Having being controlled for decades by my abusers I had no intention of letting myself fall into that position again hence I didn’t fit in very well to such a unit with such an approach.
I know that my experiences are not shared by everyone, but I also know how little psychological input is available on the NHS today, it seems to have got worse in the past decade. I see the damage caused by long waiting lists, restricted numbers of sessions and a fixed approach on certain treatments rather than an individualised client focused service. I know that people with Dissociative Identity Disorder are faced with paying privately for treatment as many NHS trusts and Clinical Commissioning Groups cannot see the benefits of a more long term flexible treatment approach to psychological inputs. Yet the cost benefits overall are significantly improved with such an approach, certain trusts operate this more longer term forward thinking approach and their findings clearly demonstrate that it’s beneficial to all parties, hospital trusts, CCG’s, the NHS and most of all the clients.
I so wish this forward thinking service was available to all those with a need, be that Dissociative Identity Disorder or other trauma related conditions, instead of being a postcode lottery. Its time the NHS invested in psychology instead of focusing just on the medicalised model of pills and more pills.
Today I am only too aware of how fortunate I am, I see someone who I actually respect for their knowledge and we seem to have an approach I find useful, It’s about an equal partnership not a power imbalanced approach. I have to work hard in my therapy it’s the only way me and the other parts of me, my alters are going to move forward. My psychologist has a vital role to play too he has a wealth of knowledge that I require and he is the person who can help me understand myself and my alters. His flexibility to use modern technology to facilitate sessions when I’m away or incapacitated is exactly what I need; I now realise that gaps in therapy aren’t helpful. Most of all for the first time in a very long time I actually feel like we are making real progress, it’s small steps but it’s progress. I can see a difference in each and every day, the fact I am starting to feel, to understand my D.I.D and most importantly my alters is proof that this approach is working.
My hope is that others are able to access similar types of psychology via the NHS, it is after all the least people with Dissociative Identity Disorder and other trauma related conditions deserve.
Copyright DID Dispatches 2014