Posts Tagged ‘mental health’

The borderline between professional and personal. Pun intended.

September 25, 2010

Please note: No offense is intended to anyone in the mental health community – whether that is a person with mental health issues or their workers, or someone affected by a family member – from this post. It is based solely on my own professional and personal experiences. I fully recognise I am generalizing by appearing to paint all people with a specific mental health issue with the same brush, and that is not my intent.

The thing about being a counsellor is that the skills never leave you, even when you spend most of your time hanging out in your lounge reading ‘Can You Moo, Too?’ over and over and over and…

I don’t mean to suggest that skills aren’t honed by experience, and that I’d be able to just waltz right in the consulting room and see five people a day after having such a long break. But the things I have learned, in my training and in experience with clients, stick with me.

Like, let’s take my dad’s primary mental health issue: Borderline Personality Disorder. This is like the personality disorder. Billed as ‘untreatable’ in some circles, and certainly it is very hard to work with people with BPD. It often comes hand in hand with other issues, such as alcohol or drug dependency. BPD itself also often means that clients are also self-harming, impulsive, etc etc.

But the main reason why we were warned off BPD so many times? It’s the problems with forming attachments and relationships. People with BPD can be really, really exhausting to work with. Even very experienced counsellors/psychotherapists might have their own personal rule of only having one BPD person on their caseload at any one time.

Its difficult to explain why to someone who hasn’t worked  – or lived – with these people. Maybe you can just take my word for it?

The other major thing that can come along with BPD is a tendency to see things in black and white, which is why these people (ie: my father) can have difficulties with relationships. For example, it is either all loved up and perfect …or a huge, festering shit roast party in hell. There is no in between.

Your girlfriend does something that you see as abandoning you? Well, obviously that’s a shit relationship and you hate her and you don’t fucking need her….but if she leaves me that will be so horrible i can’t be alone please please i need you and will kill myself if you leave…..but i fucking hate you. Etc etc.

Sometimes in counselling circles there is talk about a ‘parallel process.’ This means, in very simplistic terms, if your client is obsessed about money, you may become obsessed about money as you talk to your supervisor. Or in more easy terms – your client is fucking in love with the colour blue, so you are weirdly fixated on the colour blue….in supervision or with this client. And if you’re not good at sectioning things off in your head, the blue thing may leak a bit into your personal life.

And god help us if you already had a preexisting problem with blue, because working with this client will force you to reexamine your own blue-related issues. To question if your reactions to what they are saying are truly about the client, or yourself.

With BPD, I had some issues. Having experienced massive trauma as a child and young adult in relation to this disorder, among other things, I developed a curious ability to bear deep pain in my clients. This has worked to my advantage, mostly, though my old therapist and a past supervisor suggested I would always need to make sure I was taking care of myself – because I could bear to hear my client’s deeply traumatic shit meant I would hear it. People sense if you can deal with these things, I think, and consequently I dealt with a lot of people who wanted to go very deep.

This was a blessing, I think, derived from my childhood.

On the flip side, I seem to draw clients with (usually undiagnosed) BPD to me like a moth to a flame. On my counselling training, a pat phrase we heard a lot was ‘You get the clients you need.’ I agree with this….to a point.

BPD is very, very difficult to diagnose. It is not my place as a counsellor to diagnose. However, in one counselling placement alone, I had three major cases of clients with BPD walk through my consulting doors. None were coming to therapy about this as an issue – they were coming for other issues.  One particular person had not disclosed the issue during their initial assessment, and the therapist did not ‘catch’ it.

Oh, no, leave that to Super Existere, the counsellor with antennae 8 miles long for people with attachment issues.

The thing is, working with this person – even for the brief period I did – left me totally fucked up. I was going blank after sessions, unable to remember stuff. And the gut feeling I had in sessions? Very familiar. I was so upset by this person….who outwardly was certainly charming, intelligent, and someone I liked (I hate to put people in boxes, but again, this is ‘typical’ of BPD)….that I was reeling.

My supervisor said she felt I was in real danger. I sort of laughed. I said this could probably be explained away by my past history, especially taking into account that I grew up with a primary attachment figure who had BPD. I dutifully spoke to my manager at the placement, though. She did a bit of digging, and it turns out that this client had in fact been diagnosed with BPD by their psychiatrist (many of my clients also had psychiatrists), and…they had lost control in previous counselling sessions and their counsellor was at grave risk. Needless to say, I stopped my work with this client.

Because sometimes being a good counsellor means knowing when you are in above your head.

I don’t know how I got into a lecture on the mechanics of counselling, and this is feeling long, so cheers to you if you’ve read this far.

The whole point of this entry was for me to say that I tend to go all ‘parallel process-y’ on this blog in relation to my dad, only talking about the bad stuff. In real life, I am what psychotherapists call ‘integrated’….meaning I’m good at finding the middle ground, seeing things more realistically. It’s a good way to be, but it makes the necessary ‘black and white’ things difficult for me.

There were good things about my dad. I feel like I want to write about them, as part of a mourning or grieving process.

But actually, maybe I just needed to come here and say: I was a really good counsellor. But in counselling, I made a conscious decision to take a break from people with severe mental health issues (like BPD, for instance) and work with people who had more ‘ordinary’ problems – though often quite traumatic and extreme (because, again, I draw hardcore cases to me), but sometimes blessedly mundane.

I felt I was more helpful to people without severe mental health issues – maybe because the MH client group is prone to not turning up to appointments, etc etc – but also because I was making a choice to take care of me.

If I could do that professionally, maybe I can do it personally.

Advertisements

Not yet.

August 28, 2009

Just read this article (linked midway through) and it made me both cry and feel better.

I am feeling incredibly down about this SPD pain and the effects it is having on my ability to care for my children. I thought I had felt glum about this during pregnancy, but I had no idea. Yesterday I woke up crying, cried throughout the day, and the middle of the night festivities culminated in me repeating, ‘I am rubbish, I am rubbish, I am rubbish’ over and over again. TMD has been hovering nervously, and she took the time to read the article about postpartum depression that the health visitor gives to all new parents.

To a certain extent, I believe I am having a normal reaction to a terrible situation. However, my ‘normal reaction’ is pretty horrid, and I need to take care to be mindful of my mental health. The study linked above mentioned the devestating effects SPD can have on mental health, and I can believe it.

I feel like I am missing all the normal parts of being a mother. I can’t change their nappies. I have difficulties holding them for long periods of time, and there is no chance of me picking them up and giving them a cuddle. I can’t carry them around. I could go on and on – it is getting pretty easy to fixate on the negative. Even things as simple as not being able to shift position in bed, meaning I can’t put them over my shoulder to burp them (both of their preferred positions).

I just sob and sob, apologising to them. To TMD. I feel like I am letting my babies down. All I want to do is cuddle and care for them, and I am just as stuck in one position as I was before, and if anything, things have gotten slightly worse. I have the ability to get myself on and off the couch/bed which is lovely, but due to the fact that I am no longer sporting a giant bump. The pain has not gotten better. I am on mega painkillers now, and it still hurts more than it did when I was pregnant. Next week I am getting a home visit from a physio, and you’d better believe I am not going to fuck around with their advice. Exercise? You got it. I’ll do whatever you say, ma’am, just make me get better.

I don’t want to stay like this.

It’s a bad limbo period. The babies are two and a half weeks old – I was warned I’d still have to have the crutches for a good few weeks, but right now I don’t know whether this is a normal part of recovery, or if I will be one of the freaky few who have SPD for a long time after birth. We often have more than one medical professional in the house at a time, and I am always being referred to like this – ‘Existere has very severe SPD.’  ‘Existere is incapacitated.’ ‘Existere has SPD, which is excruciating.”In extreme cases, women like Existere may need crutches.’ (Um, hello? A zimmer frame and wheelchair, bitches.)

The word ‘severe’ is used again and again, much more than it was when I was still pregnant. Maybe they expected me to rebound. A bitter part of me, looking for someone to blame, points to the fact that the morning after my c section, they made me walk through the ward, down the hall, and to the bathroom. Thanks to that experience, I passed out for the first time in my life, an alarm cord was pulled, and I had about six people to help me back off the toilet – and wipe me. And then back into a wheelchair. I should never have been expected to walk that far, and I should have stood up for myself.

I don’t know. I can’t look at the babies while they sleep (TMD is on my side of the bed, cot pulled up so it nestles to her) because I wouldn’t actually be able to shift position or respond quickly enough should there be a vomit alert.

I feel inept, useless, a burden. I feel I am letting my children down. I feel pointless, and useless, and in love with little babies I am not touching as much as I should. I almost find myself shying away from feeding them, because I feel it is one more area I will screw up (to the second degree, though you don’t know about that yet) or let them down.

My mother asks every day, surprise and worry in her voice, ‘You aren’t walking yet?’

No.

Have another tissue, sniffy.

November 3, 2008

Home sick again. Actually got all dressed and out the door before almost having a crying fit on the way to the train – felt really hot, couldn’t stop sneezing, had a headache coming on. Felt all antsy as TMD pointed out this morning that staying home is not fabulous for my emotional well-being, and she also said that I’m likely to be feeling like shit in a few weeks when the IVF properly starts. So like, save up your time off because you’re really going to need it soon.

I am just. so. tired. Wiped out. Exhausted.

It’s rare I actually get sick sick, so this is new. Part of me wonders if I’ve ‘made’ myself sick so I can stay home and write the book. The only problem with that theory is that I’m so tired keeping my eyes open is a difficulty. ….whine, whine, whine.

Chatted with Aussie this morning; she made me feel better. As Aussie says, I’m quite stressed by the whole IVF thing already. And if staying home today helps me, then so be it. She made a point of saying that my mental health is at least as important as my physical health – and that I should do my best to feel rested and well before the injections begin on Friday.

I’m a wee bit worried as I don’t think I’m reacting all that well to the birth control pill. I hope the IVF drugs don’t turn me into a monster. At this point, though, it would be a relief to just feel like shit emotionally. Not to say I don’t find that difficult; of course I do. But at least I could say that a lot of my feelings were being amplified by the medication, and there is a quiet sort of happiness in that. While I might be a raging, tearful, snotty mess, I’ll be a mess who is trying to have a baby.

Anyway.

Be prepared to hear a lot from me today….if I can stay awake long enough to type, that is.

Grr? Sob? Grr.

October 26, 2008

Day three of taking the pill, and I am feeling crazy already. I can’t attribute the crazy to the pill, of course, but it is highly weird for me to feel this level of anxiety and sadness after I’ve already gotten my period. Normally if I’m going to feel extraordinarily blah, that happens before the momentous event of blood-in-panties.

This is even weirder since my PMDD has completely calmed down since May, when we moved out of the city. Having trees and space agrees with my mental health, surprise surprise.

I am worried about the upcoming driving test, there’s no getting around that. So these feelings are probably at least a bit related to that. My old team leader met up with me for some sparkling apple juice (we are party animals) a couple of weeks ago, and she pointed out that my perfectionism isn’t doing me any favours, and perhaps I should just loosen up. Fine. I recognise that as a good suggestion – I just don’t know how to loosen up, that’s all.

My IVF study-a-thon has said that how a woman tolerates the birth control pill can be indicative of how she will respond to the IVF meds. Let’s hope, then, that this funk is nothing more than an ordinary Sunday blahness, with perhaps a dash of fighting-the-flu thrown in for good measure. Because otherwise I’m in for trouble – as is TMD, the faithful wife, witness, and participant to me and my individual brand of the crazies.

Fucking driving test, man.

And, you know, all the other stuff too.

I used to be on the birth control pill about a hundred years ago, when man-sex was not only a viable option, but a fairly regular occurance what with my steady stream of long-term monogomous boy-relationships. The pill didn’t make me crazy then; I don’t seem to remember any side effects. But that was a triphasic pill. I don’t know what this one is. Every pill is exactly the same as the others, though, so it’s definitely not triphasic.

Some women at Day Job said they refused to take the pill because it turned them into raging monsters. Perhaps I have now joined their club. Hip hip fucking hooray!