‘You have to put your trust in the psychologist’

It was a day I won't forget in a hurry.

I was an inpatient on an acute psychiatric ward, sectioned under the Mental Health Act. I was meant to be in a place of safety. But perched on the end of my unmade bed, with tears rolling down my face, I felt so alone. I wanted to scream out for help. You'd think it would be easy – just open your mouth, and talk. But that's hard, if you are not used to it.

I felt like my own family was ashamed of me, and had washed their hands of me, and abandoned me in my hour of need. Rock bottom. The only genuine family member to stick by me was my little sister, who did not judge me. One of my two true friends throughout my life… my sister, and my own deepest and sometimes troubled thoughts.

There is only so much a person can take. We all have a breaking point, and I found mine. I had the perfect opportunity. I had unescorted Section 17 leave from the hospital, and my thought process went into overdrive. I had come to a hard and final decision – to end it. I wanted to take my own life, to end my pain and suffering.

I plucked up the courage, got off my bed and began frantically rummaging around my hospital bedroom. My room was small, bare, just the basics. I found something that resembled a pen and paper; I wanted to pen a suicide note to my family, a kind of 'thanks for nothing'. But the note I decided to leave to my younger sister was longer and heartfelt, and at the end, an apology. All of my built up emotions went into this note. I began to explain to my 12-year-old nephew, how I would dearly miss him, how proud I was of him, how I knew he will grow up to be a strong man with good principles. I finished by asking my nephew to look after his mum and to respect people, and then a P.S., 'god bless'. Bugger knows why… I am not remotely religious.

I calmly put both notes on my unmade bed, waited a few minutes, and finally plucked up the courage. I nervously asked the nurse in charge of the ward for unescorted leave to the local shop. The walk was only just over a mile and a half long, but it was the longest walk I have ever done in my life. A long walk to goodbye. I lost track of time. I can remember walking past a motorway bridge and peering over, and thinking 'just jump, do us all a big favour'… but no. The petrol station, the petrol station it is. The more negative the thoughts, the more I was determined; to end it in the most gruesome way imaginable.

When I finally arrived at the petrol station, my thoughts were racing, my heart pounding. I felt sick as a parrot, but in a sick way excited… not long now. The pain will soon be over. I noticed the attendant behind the counter. She gave off an aura, a very polite woman. By the time she realised what was about to happen it was too late. She showed tremendous courage, and I sincerely hope that one day she will find it in her heart to forgive my actions on that day.

I doused myself, head to toe in petrol. The old lady was pleading with me not to light the lighter, but I was trying frantically. It wouldn't light. Looking back now, someone higher up was looking out for me that day. If it was not for that polite attendant and the professionalism of the emergency workers, I and half of Whiston would not be here today. I owe a special gratitude to the Police Officer, and his tremendous courage. He talked me round, and I was taken to the nearest mental health 136 suite, for emergency assessment. I subsequently spent seven months receiving treatment, before being transferred to Cygnet Oaks Hospital, in Barnsley for specialist treatment.  

Treatment

31 August 2018; I sat nervously in my room, on the acute assessment ward at Swallownest Court Hospital, in Rotherham. My thoughts were all over the place. The ward manager Sue and the rest of the team came to bid me farewell… 'all the best for the future, keep out of trouble…' Was that was even possible? I had spent the last seven months of my life on that ward. Was it beneficial? To be continued…

The minibus journey went without any hitches, nearly a straight run. As we approached the main gate, at Cygnet Oaks, the cogs were going around like mad. Why am I here? For intense therapy, you idiot. My three kind escorts rang the doorbell to the main reception. The automatic doors swung open, in we walked. The start of a long journey to recovery.

The welcoming receptionist, Sharon, booked us in, and then directed us to the lodge: a 20-bed unit, which accommodates males with complex mental health issues. It was like walking into the abyss. I am six foot four inches, but I was still scared. It's the unknown, an alien environment. I was not in control. I was on a downward spiral, with no goals or future aspirations in life. I was shown to my room. It looked warm and inviting, but at the same time, very clinical. You know how you can be surrounded by lots of people, but still feel very lonely inside?  

In walked two young looking support workers, Lauren and Kerry. 'Is there anything we can get you?' 'Please miss, can I have a cup of tea?' I replied. 'Miss'… you've been in the system too long. I got a mini introduction to the ward. The lodge is a small unit, but it has ample opportunities and facilities.

Before I knew it, my therapy program had commenced. I had an informal chat with Clodagh, who was to be my named Occupation Therapist, and eventually Caroline Clare, my Forensic Psychologist. I immersed myself in all the activities that the O.T. department offered me. Walks in the country, trips to the seaside, the list goes on. Psychology, well, that was a different kettle of fish. Some people, myself included, dissed psychology. In reality, I needed psychology. But for psychology to work, you have to put your trust in the psychologist, and then start to build a rapport. To benefit from any form of psychology, you have to be very open and honest. I found that extremely hard. I had grown up not trusting people, and especially those in authority. Trusting people was a sign of weakness; I was taught this from a very early age.

My first impressions of Caroline were that she looked like she was born with a silver spoon in her mouth. What does she know about life? How wrong I was. As therapy went on, I found a new respect for Caroline. The amount of complaints that I put in against her was off the scale. But in reality, deep down, I needed someone like Caroline in my corner. She had succeeded where many had tried and had failed. She persevered and eventually managed to chip away at my shell.

The type of psychological treatment that I am receiving is called Schema therapy. Schema therapy is hard… you have to work through the pain, past emotions will be stirred up, the negative memories I had buried for many years came to the surface. When I was told about schema therapy, my initial thoughts were, what a load of gobbledegook. I had had different types of therapy before, but as I progressed through Schema therapy I began to realise I needed this type. It has not always been a labour of love, between me and Caroline; she took me out of my comfort zone. At times I just did not want to get out of bed. Caroline took the time and had the skill and patience to listen to me, and to work through my issues.

We all experience negative thinking, and emotions play an important part of this. Mine were 'offline', and this was having an impact on my life. Through Schema therapy, they have come back 'online'. I was taught the different modes, and then we worked through them. When you have suppressed them expertly for so long, and then they come to the surface, it is hard to talk about your emotions and feelings. Working through them in a safe environment is good. The element I found hard was that 'chair technique'. I did not like moving chairs. You get comfortable in one chair, and then you are asked to move to a different one. In the end, I found even that experience very beneficial.

I hope to continue a form of Schema therapy when I am off my section, and back in the community. It has helped me enormously.  

A brighter future

I am nearing the end of my journey with Cygnet Oaks. I have started to achieve many things, including studying for a BA (Honours) Law/Criminology with the Open University. I am the patient representative for the house, and with this comes a great deal of responsibility. Now I can achieve many of my goals in life, through my own hard work and especially the whole team at Cygnet Oaks. I would like to say a special thank you to my named nurse, Naomi, who has put up with me over the years. Clodagh and Caroline have taught me many things, but I will especially miss Caroline. She has been an important part of my life, and I will enjoy putting the lessons I have learned from her into practice.

I know I will face many prejudices when back in society, but I will relish the challenges. I now see rejection not as a negative. You can always change or challenge negativity, and then turn it in to a positive. That person who first entered Cygnet Oaks a couple of years ago is now leaving with a positive outlook on life, looking forward to a brighter future. I will be forever indebted to the hard work and perseverance of all the staff at the Oaks.   

- Dominic Barrett [email protected]

'We have both learnt, developed and grown as part of this therapy journey'

I'm a forensic psychologist who joined the team at Cygnet Oaks in September 2016. I have worked in a psychological setting since 2008, seeing adults with a range of different needs including complex personality disorder, mental health issues, autism and learning disabilities.

I enjoy working with people to develop a collaborative treatment plan that will meet their needs. I try to put individuals at the centre of the care; being creative and trying different ways to help people to improve their quality of life and progress in their recovery journey.

Dom's referral story felt very familiar. He was someone with a number of different diagnostic labels applied to him, someone who had previously been described as 'untreatable', and someone that was finding it difficult to find the right place. I took the opportunity to meet Dom at his current placement to get to know him better and was told 'I will do whatever Psychology ask me to… I will stay as long as Psychology want me to.' (This was one of the few times I met Dom's 'compliant surrenderer' mode…). I also got to meet someone who was strong-willed, well educated, with a great sense of humour, and deserving of a rehabilitation placement to get the help he wanted.

When Dom joined us there was understandable anxiety about starting therapy. There were mixed feelings for him as part of him wanted things to change but part of him was scared of what this could mean. I think the anxiety only increased when I introduced the idea of Schema therapy to him; he had stocked up on CBT textbooks to feel prepared for this and increase his sense of control over the situation. But I felt that Schema therapy would be helpful to start to develop a safer relationship over time, to address his unmet needs and to strengthen his 'Healthy Adult' mode.

In Schema therapy the relationship between therapist and client is seen as a key vehicle for change. It is an integrative psychotherapy that makes sense of an individual's experience by understanding their key needs such as connection, nurturance, safety and stability. For individuals who have not had these needs met consistently, they learn different coping responses based around avoidance, overcompensating or surrender. Schema therapy looks past the presenting behaviour and helps the individual to understand the key needs they are trying to meet, as well as the potential costs to other needs by meeting them in this way. Schema therapy introduces individuals to the experience of getting these needs met (using a limited re-parenting approach) and over time to develop confidence and autonomy in meeting these needs for themselves with the support of others.

Dom had been offered a number of different therapies previously and been able to show an understanding of the main concepts, make apparent progress, and in his words 'tell them what they wanted to hear'. His avoidant modes were well established and the Schema therapy model provided a lovely framework for introducing that, making room for it in therapy, and softly being able to reduce Dom's need for its presence in the room so that therapy, and psychological healing, could take place.

I was lucky that Dom started to be able to show me parts of his vulnerable child side fairly early on. Staying connected to this part of him, and making sense of all the different and interesting ways he had learnt to mask this side of him, helped me to develop warmth and empathy. It also helped me not to take things personally when his complaining protector side kicked in! Exploring the coping modes with interest, compassion and gratefulness that they had helped Dom survive a number of difficult experiences in his life made a lot more sense to me. It also helped Dom to make sense of his experiences, rather than just being told what to do (or not to do) as part of therapy. Being able to be curious also started to slowly chip away at his feelings of shame that at times had been debilitating for him.

Dom needed a lot of support to challenge his critical mode which often drove his need to be avoidant, his need to put others down to feel safer himself, or his thoughts of hurting himself or others. His resistance to the 'musical chairs' (chair work) was just one of the ways he used humour to push himself through the difficulties of therapy. But using visual cues and chair work helped understand the impact the critic had on him, how it was irrational or unreasonable at times, and the long-term effects of letting the critic drive his behaviour. We used visual prompt cards, a lot of repetition, and behavioural experiments to weaken the impact of the critic. Experiencing the imagery of limited re-parenting was also new and understandably triggering for him initially. We persisted, and the experience of seeing Dom experience and ultimately start to enjoy or benefit from these more nurturing and compassionate exercises was particularly inspiring.

Over time Dom became less critical of himself and stopped blaming himself for his early experiences. He practised compassion for others and, eventually, himself (the latter took a lot more time and practise as is often the case). Strengthening his healthy adult mode to join us, and then to look after his little side on his own, is something that has given me a sense of both pride and admiration.

Dom also helped me to challenge my own critic mode and avoid taking a Psychology textbook with me on holiday, so I can confidently say that we have both learnt, developed and grown as part of this therapy journey. He has particularly enjoyed that asking me to write this article has pushed me out of my comfort zone and required me to challenge my critic as well.

I am grateful to Dom for sharing his story and experiences. I hope it helps inspire other people to seek the support they need, or to consider the different therapy models we can use with those that we care for.

Caroline Clare