It’s not lounging on a couch, telling a patient man in glasses and a tweed jacket about your parents, and having them say ‘ah, yes. But how do you feel about that?’.
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It’s not just a nice chat with someone who’s paid to be interested in what you’re saying.
It’s definitely not just a place where you go to iron out your relationship issues or bitch about work with full freedom to be as self-involved or needy as you like.
Therapy is tough. It’s really tough and you have to stick with it through rough sessions and periods for it to work.
In my first session (done online in the hopes of a shorter waiting list, four months after my original chat with my GP), I had to talk about all the stuff I’ve spent years keeping locked up in a black box with no holes in a secret, off-limits place in my head: the thoughts I’m ashamed of,memories that had been suppressed for thirty-two years the low points I’ve never admitted to, the things I’ve done that still twinge with shame. Events that had happened out of my control that I carried the guilt for since a child.
Spilling that all out wasn’t so much a weight off my shoulders as a dip back into my lowest depths, letting myself stew in all the bad bits as I spoke them out loud and made them real. I hadn’t been prepared for that. I had thought it would be a weight off my shoulders. It was the opposite. It just opened the floodgates to untold trauma and Complex PTSD. I had to admit to owing the diagnosis given to me by my Psychiatrist.
After that session I cried and cried. Afterwards I couldn’t sleep. I felt like I’d brought up a lot of stuff that I wasn’t entirely ready to deal with – decades of suppressed memories, filled with panic, and doing damaging things to block out what was happening in my head.
The next session brought more tears.
This time round we spoke about the traditional therapy stuff – when my issues started, what have been the triggers and, the classic, my relationship with my parents. The toxic damage caused.
It was feeling pretty heavy. Then my therapist brought up exactly what I was thinking: this deep dive into my issues was probably important, but when would I start doing what I came to therapy to do – learn how to get better?
She explained that, while the last two sessions had focused on my past, CBT (that’s cognitive behavioural therapy) is very much about focusing on the present and future. It’s about equipping you with skills so you know how to deal with things when they come up, rather than psychoanalysing all the various ways your childhood messed you up.
The next sessions wouldn’t be reminiscing – they’d be work, learning skills, changing behaviour, and putting in the effort to do things in a better way. She warned me it wouldn’t be easy, and that CBT only really works if you’re genuinely committed and ready to change.I explained that at this point, I’d do anything to feel better and get some control back over my thoughts.
So we started with a bit of homework. For the next week, each time something set me off (either into a spiraling low mood, a panic attack, or a bout of obsessive thoughts), I’d need to write down four things: situation (meaning what’s going on), emotion (how I’m feeling), thoughts (what I’m thinking), and behaviour (what I’m doing).
That’s right – therapy has homework. You actually have to do stuff, rather than having someone tell you all the answers.
The next session, as promised, started to focus on the here and now.
We decided to approach one challenge at a time, starting with my social anxiety a comorbid condition my Complex PTSD which was making it really difficult to work and just generally get out of the house (prompted by my recap of what had happened the weekend before, involving me going to a gathering, having three panic attacks in the bathroom, then storming off home because I just couldn’t take any more).
We went through my usual pattern.
If I’m feeling really, really anxious, I just won’t go to the party/dinner/work drinks. I’ll make up an excuse at the last minute, usually when I’m already dressed and ready, bail with a bunch of apology texts, and spend the rest of the night feeling guilty.
If I’m feeling a bit on edge, I have a rule: I have to stay at whatever social event it is for forty minutes. After that time, I might be having fun, in which case, hooray. But if I’m not, I have permission to go home. My therapist asked what would happen if I stuck around a social event, instead of running away at the first hint of trouble. I explained that what would likely happen is what went down on the weekend – trying to drink to take my mind off things, then crying in the toilets as everything became overwhelming.
She set me a challenge: what if I were to stay put and see what happened? What if I went to a social event, started feeling uncomfortable, but rather than having an escape plan to hand, I just stuck around and observed what happened?
The idea of that, frankly, sounds pants-sh*ttingly scary. I admitted that, but said I’d be up for trying it to see what happened. In all honesty, I thought we were talking hypothetically. ‘What about this week?’ she asked. ‘Can you choose to do something that’s a three out of ten on the fear scale, and try sticking it out?’ We decided on a social event and I wrote it in my planner. I won’t be drinking. I won’t be able to run away after forty minutes. I have to challenge myself to stick around.
To anyone without anxiety, that sounds ridiculously doable. But when every part of your mind and body is telling you, loud as an alarm: ‘nobody wants you here, you’re going to do something stupid, you’re dumb, you look awful, what if you do something and make everyone hate you, get out, get out, GET OUT’, forcing yourself to stay seated and talk to people like the totally chill, breezy person you want everyone to think you are feels impossible.
And that’s what CBT asks you to do. It asks you to do stuff that makes your stomach sink, and challenges you, and makes you deeply, entirely uncomfortable.
CBT is about breaking out of all the routines and rituals you’ve been trying to use to stay sane – the escape routes, the alcohol, the distractions – because it’s about accepting that they aren’t really working.So, yeah, it’s bloody difficult. I can tell it’s not going to be an entirely pleasant journey, and there’ll be moments that’ll make me wish I could retreat back into my cosy cocoon of pretending I’m totally fine.
And we’ve only just started. We’ve still got the depression, the panic attacks unrelated to social events, and the obsessive thoughts to look forward to.
Therapy is work. It makes your mental health a project that you have to be willing to work on. It’s absolutely not someone telling you a secret hack that fixes all your problems in an instant.But I can tell it’ll be worth it.
Every tough bit, every challenge, and every low point, will help to break down the habits that were making me miserable, and help me to see things more clearly, without a haze of distractions and self-medication. Every time it feels uncomfortable, that’s just the feeling of change, of learning, of getting better. My history of self-harm has left me with scars – this is how I feel about them
Sinking into depression, anxiety, and obsessive thoughts wasn’t as simple as one bad thing happening and then falling apart, so, naturally, sorting myself out won’t be as simple as being given some speedy advice and being sent on my merry, medicated way.
Therapy is going to be tough. But after years of running away, I’m ready to face up to the challenge. I’m ready to work towards getting better. The next step following the CBT program which we worked though which was successful for my anxiety was starting EMDR for my Complex PTSD and trauma. It is an an extraordinary journey reprocessing the flashbacks of my childhood abuse and enormously difficult requiring gargantuan levels of trust in my Psychotherapist. I will write about that tomorrow. It has been harrowing but has aided in my journey towards healing in the most wondrous way.