Moments in Time

I can’t recall the film, but I am sure I saw something once where there was a monologue that lamented about ‘moments in time’ and how things can change quickly and unexpectedly in life.

It is likely the film was very bad as it is a very vague recollection on my part, but whilst I was talking to my first client of the day today, the phrase popped into my head and wouldn’t leave me.

I will explain.

I have been working with this client for approaching two years. Complex work, lots of deep-seated issues relating to trauma and attachment which have left the client with little to no self-esteem and an internal self-view that is almost completely negative. This gives the client an overt permission to self-harm when triggered and leave them regularly overdosing and planning how to end their life.

We have been working through things together and it has been slow but steady work, with lots of bumps along the way. The kind of things this client struggles with are never easy to work with and there is never a quick or easy cure for issues that have grown ever more complex as the person has grown and had additional negative experiences which further confirm their negative feelings around themselves and fuels their desire to self-harm and die.

What has this to do with ‘moments in time’ Mark I hear you cry.

Well. This client was referred to an NHS psychiatrist after an admission to A&E following a suicide attempt. We talked about whether the client should go and the client was keen to attend and be seen as looking after themselves by being good and doing what was expected of them.

It is not a therapist’s place to tell a client what to do or not to do, so I supported the client’s decision to attend and held my reservations back in my mind.

I saw my client this morning for the first time since the appointment and this is when the ‘moments in time’ phrase started to repeat like a mantra through my head. In the space of two hours the psychiatrist had managed to undo nearly two years’ worth of complex relational psychotherapeutic work in just a few simple steps. The psychiatrist had told my client that:

  • Because they have a family and a job, they have met the necessary ‘life stages of development’ and are therefore functional in all aspects of life.
  • The only problem the client has is that they ‘confuse their feelings and thoughts’ and if they can just change their thinking, they will be fine.
  • They don’t need counselling or therapy; eighteen months is too long to be in therapy anyway. Dialectical Behavioural Therapy (DBT) is what they need as it will change their thoughts for them.
  • Essentially, the client is fine, they have a job and stuff. They just need to ‘man up’ (my phrase here, but it is basically what the client was told) and stop self-harming and trying to kill themselves.
  • They don’t need any meds as they are functional and meds wouldn’t help as a result.

So, in two hours, a client with a complex childhood history of loss, trauma, abuse and neglect is told that they are wasting their therapists time, they are really fine and shouldn’t make such a fuss about their experiences, they shouldn’t bother people with their neediness and manipulative behaviours because they are fine. They have a partner, family, friends and a really nice job, so they shouldn’t have complex negative feelings about themselves at all, they can just think their way out of feeling like they want to die or cut themselves deep enough to cause serious infections and leave scars that will never fade and be there to always remind them that they just need to think differently and it will all just stop.

That is rambling I know. But it is how the client felt this morning. Confused, bereft that their negative beliefs about self have been confirmed by a psychiatrist and therefore must be true, feeling that they are wasting my time and that they shouldn’t be in therapy and that their internal voice that tells them they are shit, manipulative, wrong, bad, selfish, mean, worthless and nothing to nobody, has actually been right all along.

Nearly two years work undone in just under two hours. Well done NHS, well done psychiatry.

I do not apologise for the tone of this blog. I have been fighting this system based on a flawed medical model belief that all problems are neurological in cause and cure and banging my head against an inflexible and broken NHS for sixteen years, and things seem to be getting worse rather than better. It will likely take me weeks to get my client grounded again and there is always the chance that I will not be able to and the client will choose to leave therapy.

If that happens, then the client will be alone with their inner voice that permits them to hate themselves and cut themselves to pieces, as well as encourages them to fantasize about jumping off bridges and into traffic (it even gets them to drive onto the bridges sometimes and stand looking at the traffic).

I wonder how many clients this psychiatrist has assessed previously who haven’t got a therapist or friends or anyone to talk to after being dismissed and belittled in the way my client was, went on to kill themselves. I fear it is likely more than one or a couple, I fear it is likely to be many and there are many psychiatrists, psychologists and even counsellors and psychotherapists who believe what they believe and push those beliefs onto vulnerable people every single day. I sometimes despair…..

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