The Difficulty Of Losing A Therapist

Over the past few weeks, I feel that I have been going through what is commonly referred to as “a break up”, one of those horrible experiences that, in popular culture, is often portrayed as a situation that can only be remedied by much crying into tissues and several tubs of ice cream. Now I know what you are thinking, “but Katie, how can you be going through a break up when you yourself admitted the day before Valentine’s Day that you haven’t been in any kind of romantic relationship for over two years” (alright don’t rub it in guys…Jeez).
Well if you thought that, you would be right, no, I haven’t been in a romantic relationship for a very long time (aside from the one I am in wth Helena Bonham Carter that she isn’t aware of…yet), but in the world of mental health there is a common experience that is very like a break up, that being the loss of a therapist.

Now, before I go on I would like to preface this by saying that I do not mean for this to imply that I am caught up in any romantic entanglements with the therapist I am referring to and who is currently in the process of “leaving me” for a new job.
Indeed our relationship is very much the standard “patient/psychologist” affair (perhaps affair wasn’t the best choice of word there…). However, what I don’t think a lot of people understand is just how attached one can get to a person who only hangs out with you every week because they are paid to do so.
It a very odd situation, and whenever a therapist leaves I feel I should deal with it easily, without being particularly bothered. This is after all not a new experience for me, as I have literally lost count of the number of therapists that have left me over the years, (seriously if you rounded them all up you would have more than enough of a cast to put on a performance of Les Miserables and trust me, from someone with a theatre background, you need a lot of people to perform that show). That said I know a lot of people find this a very difficult thing to go through, and rather than it mean we are clingy or weird, I think it makes a lot of sense.

Yes, a relationship with a therapist is strictly professional and should, on paper, be the equivalent relationship to someone you have hired to be your private chef (who is paid for by the NHS because you are mentally unable to sustain yourself alone….I need to work on my analogies…)
The chef turns up at your house because it is their job just like my therapist turns up for our appointments, but when you are talking about your deepest darkest secrets and fears rather than how you like your eggs cooked, it can’t help but become more personal whether you intend it to or not.
In every other professional relationship you have with someone who is being paid to spend time with you, like a chef or a plasterer in your house, the reason for their being there is in reference to something separate, aka food or dodgy walls. With a therapist though, unsurprisingly, a lot of it is about talking about your life. How can that not be personal?
Ok other professional relationships have personal aspects to them as well, a private chef for example may eventually grow to know how much milk you like in your cup of tea without asking every time, yet with a therapist there grows a level of intuition that is less about knowing how you like your tea and more about being able to simply look at your face and know automatically that it is time to put the kettle on (although I would like to clarify that my therapist has never actually made me a cup of tea at all…if you are reading this dear therapist, maybe work on that in your new job). It is that deep connection of being understood as a person, and for that reason of course it can be like a relationship break up when a therapist retires or leaves to get a new job.

Again, of course I am not saying that it is in any way romantic and unlike romantic relationship endings we are not going to be left wondering who gets custody of the kids (we already decided in our first session that I get them Monday to Friday and then she has them over the weekend). Nevertheless I am left wondering what I will do without this person who is currently a big part of my life.
When you see a therapist for a long period of time, discussing your mental health problems/building a therapeutic relationship is sort of like building a house. In the beginning you have an empty plot of land and the patient has a hell of a lot of bricks (bricks that in terms of this analogy represent secrets/thoughts/things that make you as a person). The patient is standing in the middle of this messy pile of bricks without any idea of how to deal with it, so the therapist is there as a sort of builder/tidier to help sort it all out. Every week you both turn up at this plot of land and gradually, the patient hands the bricks individually to the builder. Together you try to construct something that is a little less of a mess, and a little more something you can work in. The more you talk, the more bricks that come out, and eventually the house is finished at which point you can go inside and start trying to make the place liveable. You try things out, experiment with fuchsia walls, checkered wall paper or new therapies and you see what works for you.
Then finally you get to the point where you can both walk into the house (aka brain), and know the insides and outs of it so well that one of you can reference something within the house and the other will know exactly what they are talking about. Refer to the “plant thing in the bathroom” and they know what that plant thing is as well as when in your life you bought it and why it is in the house, just as a therapist will eventually grow to know all about the way your mind works as well as any life events you simply reference to as “that time with the giant squid”. If anyone else comes in the house and you reference the plant thing, they don’t understand exactly what you are talking about. Even if you take them to the room to point it out they cannot have the same level of understanding as the person who helped you build the bathroom in that particular way and find that particular plant at the gardening centre. You can tell a new therapist about what happened during “that time with the giant squid”, but to them it will just be a story rather than an experience you have lived through together.
Getting a new therapist then is not as simple as the professional transition involved when you get a new plasterer for example (I have just realised there are a hell of a lot of interior design analogies in here which I think is in reference to my love of 90’s TV show Changing Rooms. I miss Carol Smiley. Where did she go. She was so Smiley). No, instead of a new therapist coming in to help you in the house you had made earlier, it is like having to smash all of that “brain internal understanding relationship” stuff to the ground and having to start again. Once again you need to start passing them all the individual bricks they have never seen before, so you actually have a long time of simply building up enough of a rapport/understanding before you can get on with any of the serious stuff.

Like the end of any romantic relationship you find yourself wondering if you will ever find someone you will get on as well with or who will understand the way you work in the same way, and the first sessions with a new therapist are very much like all the first dates you have to go on to try and find a new partner. Conversations go from deep personal investigations into the meaning of life to the cookie cutter “so what is your job”, “where do you live” standard statements that you have to go through before you can get to anything of real interest or value.
Unlike a first date of course, a new therapist will probably have all of your notes from the previous one and thus a rough knowledge of your history, but nevertheless, with or without these notes they will always say that they want to hear about your history “from you”. Admittedly this is a good idea. Obviously I can explain something that happened to me when I was eleven better than a therapist was able to jot down in a word document, but having to go through all that stuff is exhausting. Maybe if you don’t have a huge mental health history this “tell me about you” question can be answered relatively quickly, yet for me it is a question that is incredibly daunting. Tell me about your experiences with mental health services?! How can I do that? We have nearly 14 years of appointments to catch up on! I can’t get through all that in one hour!? DO YOU HAVE ANY IDEA HOW EXPENSIVE HOSPITAL PARKING IS?

This entire blog is probably just one long incoherent ramble so half of you reading will be probably wondering what the hell I am talking about and who the hell Carol Smiley is. I guess I just wanted to raise some awareness of how difficult it is when a member of your therapy team has to change and why it feels so much more impactful than a change in any other strictly professional relationship. If I was ruler of the world I think I would probably make it law that therapists are unable to ever get new jobs, retire, change jobs or go on maternity leave (sounds ridiculous I know but in terms of fair/rational leadership I would still be doing a better job than Donald Trump.)
Luckily as you will know if you have been around my blog for a while, I do have a whole team of therapists so it isn’t a total break down of my psychological support and only one person is changing. I also know and like the replacement very much so it is as “good” and manageable a “break up” as it can be. Nevertheless I can’t help but feel as though in a few weeks when it is time for our last session (on the 21st of March, put that in your diary folks), I will be losing someone very important, someone who I can trust and rely on, so naturally, this isn’t going to be easy.

Take care everyone x

therapistchange

Unveiling The Secrets Of Life As A Mental Health Nurse

As you are probably all aware, this blog is a blog about mental health.
If you weren’t aware and thought this was actually a blog offering gardening tips, then I am sorry to disappoint you, but I really have no advice to offer in that department so you may want to look elsewhere for tips. All I know is that you should water your plants…but not too much…and plants need sunlight…but then some like to be in cool dark cupboards…yeah like I said I really am not qualified or experienced as a gardener…ANYWAY, browsing the titles of my current collection of posts I have noticed that most of them are aimed at people with mental health problems, but what about a post centred around the people who spend their lives trying to treat those without marbles? How do they feel about working with the mentally ill? What do they like about the job and which parts make them wish they had steered clear of the anxious and the depressed inhabitants of this godforsaken planet, to pursue a career in fish mongering instead? What makes them dream of swapping therapy for cod and medication side effects for a nice piece of haddock? What advice do they have for people thinking about becoming a mental health professional and how does one go about following that dream? If the mentally ill are plants, who are the gardeners providing enough warmth for seed germination and growth? (Please note I just used the word germination…that is a gardening term…maybe I am more qualified in that department than I realised). Well, if you have wanted to know the answers to any of these questions and even if you haven’t, I am here today to give them to you anyway in a hard hitting interview with a real, qualified mental health nurse working on the ward in which I currently reside. Prepare yourself for the secrets of the mental health professionals, the story behind the shift work and a very confused nurse wondering what on earth I am talking about…

LIGHTS GO UP.

[The nurse and I are seated in blue chairs in a place known as “the quiet room”. The conversation begins whilst the sound of the cleaner mopping slops rhythmically in the background]

Me: Hello Nurse Gertrude Potatobucket, thank you so much for joining me today for this interview.

Gertrude Potatobucket: What interview? Who is Gertrude Potatobucket?

Me: This interview. I want to know about the life of a mental health nurse for an article on my blog. Also you are Gertrude Potatobucket for the duration of this interaction because I am hiding your real name in the interest of confidentiality, so you can be brutally honest as nobody will know your true identity.

GP: I will agree to the interview but can’t I pick another name? Why does it have to be Gertrude Potatobucket? That sounds ridiculous.

Me: I will have you know it is not at all ridiculous but is an underused name that deserves more recognition, so no, you cannot pick an alternative. Anyway, I’m supposed to be the one asking questions here so please just accept your new identity and lets get to the good stuff.

GP: Katie I really think…

Me: [In a loud and interrupting manner] QUESTION ONE. WHAT DOES BEING A MENTAL HEALTH NURSE ENTAIL?

GP: [Sighs…there is a long pause during which the sound of mopping appears to increase in volume until Nurse Potatobucket realises that she is going to take part in an interview whether she likes it or not and gets on with answering the question at hand]. The role of a mental health nurse is different depending on what kind of service you are working for but in terms of my responsibilities on this Eating Disorder Unit, I am in charge of co-ordinating health care assistants on shift, running support groups, working with patients in 1:1 sessions, supporting them at meal times and I am in charge of handing out any medication prescribed by Doctors or psychiatrists.

Me: What a busy bee you are! I can almost hear you buzzing, your face is practically aglow with black and yellow stripes. So tell me Gertrude, how did you earn such responsibility? How does one go about becoming a mental health nurse? What training is required?

GP: To be a mental health nurse you need to have at least 5 GCSE’s including maths, English and Science and then go to university for three years to study mental health nursing. You don’t have to go to university to work in mental health though. If someone wanted to be a Health Care Assistant they would need to have something called a care certificate, but it is possible to get a job as an HCA without any official training. If someone has experience in mental health and does a good interview for a job, they may be offered a position and then have the opportunity to do the care certificate whilst working.

Me: Well to qualify alone sounds like a lot of fun but how about the job itself? What would you say is the best thing about being a mental health nurse?

GP: Supporting people and helping them to make positive changes in their lives.

Me: How nice. I don’t want to paint a misleadingly fluffy picture about the job though so tell me, what is the worst thing about being a mental health nurse?

GP: You see some really sad and upsetting stuff. Also shift work can be difficult as you never have a fixed schedule or routine and can be working at day or night depending on your rota. That said I know that “Bertha Potatonose” likes shift work as it enables her to be flexible when looking after her children, so it is different for everyone. Oh God I have just used her real name, can you cut that bit out?

Me: No need, I will simply hide her identity by replacing her real name with Bertha Potatonose.

GP: What is it with you using the word potato in fake surnames?…

Me: [Even louder and more interrupting than the first time the interviewee started to question the interviewer] QUESTION FIVE: HOW DOES BEING A MENTAL HEALTH NURSE AFFECT YOUR DAILY LIFE AND WHAT ADVICE WOULD YOU GIVE TO SOMEONE WHO WANTED TO BE A MENTAL HEALTH NURSE?

GP: [Sighs. Despair at the situation is visible. The cleaner is still mopping in background]. First off I would advise someone to get some life experience or experience as an HCA. Secondly I would say that in terms of daily life you really need to learn to leave work at work and look out for your own wellbeing at home. You can’t look after someone else unless you have first looked after yourself.

Me: Does this mean there any people then that you would advise to avoid looking into being a mental health nurse? Are there any people you feel would be particularly unsuited to the role?

GP: No. It can be a difficult job but anyone can be a mental health nurse. Different people bring different life experiences, skills and character to the job and I think that is important. Mental illnesses don’t all fit into a neat box and neither do the people who are able to be great Mental Health Nurses.

Me: Inspiring. Truly inspiring.
Now Ms Potatobucket, I know that the people at home often worry when speaking to a mental health professional in candid honesty about their condition that they will be thought of as “crazy” or “weird”. Answer me honestly, do mental health nurses ever judge patients regarding what they say in a session?

GP: No, there is never any judgement. All I feel towards people talking about their difficulties is empathy and I want to show compassion towards the difficult time they are having in life.

Me: Well that is a relief. I am sure we will all rest easier in our beds tonight knowing that we can spill our inner most thoughts without fear of being thought to be “weird”. In addition to worries like that, a lot of people in treatment out there may also be struggling at the moment and feeling like things will never get better. Do you think recovery from a mental illness is ever really possible?

GP: Definitely. All mental health nurses hold the hope and belief that the people they are treating can get to a better place. I think everyone is capable of building the strength and determination not to let their mental health problem rule them forever, and in learning skills they can gain confidence they may not have had initially in fighting their issues.

Me: Fascinating stuff Gertrude. Truly fascinating. Now finally. The question everyone at home has been waiting for and the most important piece of information in all of this. Tell me, has being a mental health nurse in any way altered the opinion you hold with regard to penguins?

GP: What does that have to do with working in mental health?

Me: [Incandescent with rage at being asked a third question during the interview] MS POTATOBUCKET

GP: Oh for goodness sake ok, yes, being a mental health nurse has given me a new found appreciation for penguins.

Me: Aha! Just as I expected! Gosh! Looking at my watch it appears we are all out of time! Thank you so much for answering these questions Nurse Potatobucket. Your honesty and words will touch millions. On behalf of all my readers please know that we are eternally grateful.

GP: Can I go now?

Me: Absolutely

[Interview ends. The sound of mopping in the background has stopped. Upon leaving the room the cleaner is nowhere to be found and only a mop lies in the corridor. The cleaner has not been seen since…]

FADE TO BLACK

Well there you have it! The hard nitty gritty truth about what it is like to work as a Mental Health nurse, how to become one, and how such a career can affect one’s opinion on monochrome birds who refuse to comply with society’s expectations and use their wings to fly. I really hope that this helped people out there either if they are thinking about becoming a Mental Health Professional or those in treatment worrying about what carers in an inpatient setting may be thinking. It appears there is no judgement when it comes to working with the marble-less hoards and no matter how it feels at the time, it seems there is always hope and the potential to recover.
Now if you don’t mind me I am going to abandon my job as journalist for the day and turn to a little detective work. I really am getting worried about the case of the mysteriously disappearing cleaner that took place during this interview…any witness statements would be appreciated in the comments.

I will speak to you all next Monday, take care x

 

Gertrude Edited