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“Borderline? That’s Not a Diagnosis, That’s an Insult!” Obligatory Assessment Session Review Post

Posted Sep 01 2010 5:18pm

It – the impromptu counselling assessment session with the Nexus Institute on Tuesday 31 August – went well.  Thank you all very much for your lovely supportive comments , tweets and Facebastard messages.  It meant a lot knowing that my great online friends would be there to provide a figurative shoulder on which to cry, regardless of how the appointment went; your encouragement enabled me to face said meeting with more confidence than I might otherwise have expected myself to do.

To be honest there’s really quite a limited* story to tell; it was, after all, a mere assessment session.  What’s more, there is far from any guarantee that I will actually see the bloke I met yesterday in a capacity as my “counsellor” as opposed to simply my assessor.  The way it works is that you’re put on a list, which is dependent on the location in which you wish to be seen, and that when a therapist in said location becomes available, you are offered his or her first available appointment (within brackets that also suit you, of course).  I had told them several times that whilst I am theoretically tolerant of being allocated a woman on the off chance that I might be able to engage with her, I would really prefer a man.  However, I get the impression that either (a) they have more men working for them than women or (b) most of their clients request female counsellors, because they seemed not to worry too much about this and told me I would get seen quicker if I said either would do.  The point I’m making is that if these factors did not apply, I would have expected them to have given a lot more weight to my concerns about the therapist’s gender.

Unfortunately I’m now neurotic about this in the extreme.  I really don’t want to see a woman, whatever her skills or character may be.  Should I email them and ask them to note this more definitively?  I feel like a bit of a cock doing so; I am, after all, a woman myself and indeed a feminist (though perhaps something of a post-feminist feminist, but this is not a blog about theoretical political philosophy, so I’ll not get into that).  But on the other hand, even though you can change your counsellor after meeting them if you don’t ‘click’, why waste their time and mine if I can already predict now what may well be the case if a woman is allocated to my therapy?

Anyway, I’m getting off the point.  In terms of this blog, I had become sick of so impersonally referring to C as ‘C’, so now that he is apparently out of the picture (though a letter from the Trust of Evil is en route from my mother’s house to mine as I type…oooh-er), I’m going to abandon initials for new characters in this weird theatrical dance detailing my life, ergo calling the bloke I saw yesterday Paul.

In some subtle ways Paul was/is the polar opposite of C.  He was fat, cheerful and extroverted, as opposed to skinny C’s soft and gentle introspection (leading to a lot of smugness on my part on the occasions on which I actually made him laugh).  C’s probably about 34 or 35.  I’d guess that Paul is at least 10 years older.  He wore a loose (and therefore rather immense) blue shirt, untucked, which sagged at his navel, revealing his belly-button.  This disturbed and amused me in equal measure.

At first I was dubious, probably because he was not what I’d expected – though having said that, I didn’t expect anything in particular, because I know that that always leads to disappointment.  He led me up the stairs to a very pastel-ish, counsellor-ised but not-quite-as-offensively-so-as-I’d-expected room, making smalltalk about traffic and whatnot as we walked.

He sat down opposite me, and welcomed me to the Institute, giving me a quick lowdown on how the assessment session was likely to proceed.  To all intents and purposes the procedure was as you’d expect from any assessment that has even the vaguest relation to mentalism, which is generally a frustrating and upsetting thing – but something in his jovial manner managed to put me at my ease, and I felt able to talk to him with only a small amount of reserve.

Most of the questions Paul asked me were your standard-ish, predictable but necessary-for-this-kind-of-thing bollocks.  Name, address, GP, consultant, employment status, educational background, significant relationships, the specifics of your family tree, any medications (“ah, Seroquel?  Very popular these days…”).  He eventually got round to asking me about my physical health and then,  in an almost sheepish or embarrassed fashion, he made enquiries about my mental health.  The question’s rather abashed nature was caused, I think (well, I know) by a number of allusions I’d already made about being off school, university pr work due to depression and related issues.  I laughed out loud thinking about it, which he appeared to have expected.

I gave him the lowdown on how I was diagnosed with clinical depression as a young teenager and social anxiety as an older teenager.  ”More recently,” I went on, “I was told that I have complex PTSD.  And, of course, the dreaded borderline.”


I shall now interrupt this broadcast with to bring you an “infomercial” on the evils of “BPD’s”, “Cluster B’s”, their primary enablers Mental Nurse , and my now seemingly infamous quote of I still haven’t taken my tablets.  Normal service will be resumed forthwith.

Click here to view the embedded video.

Hello!  I’m back now.  So yes, anyway, Paul.  I added the reference to ‘borderline’ in referencing my not-inconsiderable collection of psychiatric diagnoses.  Paul was making notes of everything that I’d told him, but I noted with interest the sharp and disgusted intake of breath as I rolled out that particularly hideous word.  He continued writing for a minute, finished the section he was at, then put his pen down and looked up at me.

“‘Borderline’,” he repeated.  ”I hate that concept.”

I reckoned he was being supportive in his hatred – ie. I believed that he felt that BPD was a defiling, often unfair diagnosis rather than that he felt that people with the disorder, having as they do an inaccurate but traditional image of being manipulative, abusive bitches, were the ‘concept’ worthy of dislike (which of course abusive, manipulative people are, but it applies to many people without BPD, just as it doesn’t to many with the illness).

“Yes,” I started uncertainly, just in case my perception of his view was incorrect.  ”It’s not a very well-liked diagnosis, is it?”

“I don’t think it is a diagnosis,” Paul responded.  ”It’s just an insult.”

OK – a bit harsh, I though, but definitely on my side, so fair enough.  There followed a brief discussion on how so often BPD is thrown at young women who either (a) self-harm or (b) don’t take shit from nor lie down and universally accept everything said from psychiatrists.  I told him that I felt I certainly met the requisite five criteria for a fair diagnosis, but I knew that so often that wasn’t the way of things, and that in that regard I had been relatively lucky.  He agreed that so often it’s just slapped on someone’s forehead because a psychiatrist merely had a ‘difficult’ interaction with the patient, and then spent a few minutes complaining about how such “labelling” (a term that, in this sense, I despise) demoralises and stigmatises vulnerable people, and renders treatment from the NHS mental health system difficult because of its complete unwillingness to provide adequate therapy for such conditions.

Of course, my own story came into play at several points, and this was no exception.  I told Paul how although I had seen C since February last year, that we met only once weekly and that the whole thing amounted to just over a year’s therapy in real terms – in complete and utter contravention of the cocking NICE shitelines, of course.  I admitted that I had only relatively recently come to a point where I had began to trust C enough to share some really nasty, hardcore (no puns please) stuff with him but then, right in the midst of the resulting psychological whirlwind, I found myself inexplicably being chucked out of the sorry system like a bucket full of dirty dishwater.

He put down his pen again, and sighed, annoyed apparently.  ”I hate that,” he intoned, shaking his head disapprovingly.  ”I hate it.  It just leads to further difficulties, doesn’t it?”

Um…YES!  Thank you for seeing that independently of my pointing it out, unlike every pathetic overpaid cunt with whom I have dealt within the health ‘service’.  I confirmed my agreement by referring, yet again, to my retraumatisation issues resulting from how things with C ‘progressed’, ‘developed’ and ended.

In discussing my history of treatment, I mentioned the failed referrals I had had from the Crisis Team and some CPN or other for CBT, as well as my brief but deeply regrettable experience of it in the private sector.  I was surprised to note a cynical smile creep surreptitiously across Paul’s jovial face.

“I just don’t think there’s any way that CBT, even with the most skilled therapist, would work for you,” he told me.  ”I mean, that’s a big judgement to make on the basis of having known you for half an hour, but you really strike me as being…” –  he searched for some sort of half-formalised sort of term – “well, somewhat ahead of that.”

I suppressed a satisfied, vindicated smile.

He continued: “I don’t think that CBT solves everything in the way the government would like to portray it as doing.  It works for some people some times, but it’s not a blanket solution.”

“Indeed,” I concurred.  ”The only reason that it is touted as a fits-all mental health panacea is because of the health service’s obsession with targets and costs.”  He appeared to be impressed with this brief diatribe.

Eventually, given that Nexus is an organisation devoted to counselling those that have been sexually abused, he inevitably had to ask questions about that.  When I said something to the effect of, “I was raped from the age of five,” he sighed yet again and told me that although he had heard similar words spoken many times before, they “never stop affecting” him.  Of course, it is inevitable and necessary that therapists distance themselves from their work to some extent, but it’s also good to know that they (or at least he) still have some feeling about traumatic and difficult issues; I mean, how could they develop any sort of empathy otherwise?

I found two of his questions especially difficult.  The first one was why I was coming to see the Institute now, as opposed to five, ten, whatever years ago.  After umming-and-ahhing for a bit, I concluded that for all the trouble that my relationship with C had ultimately caused me, that in fairness he (C) had apparently brought me to a point where at least I knew and accepted the reality of my history, even if I had not been able to fully explore and resolve the difficulties and specifics thereof.

“To that end,” I said, “I now want to face up to it, to discuss it…even if it’s as hard as it will inevitably be.  Before now, I seemingly just dissociated or ignored or somehow otherwise mentally compartmentalised it, but of course burying stuff deep in that way only leads to intangible but at times almost unbearable surface suffering.  So, I want to fully address that now.”

The other awkward question that was asked was what I wanted to achieve in therapy with Nexus.  I’ve always hated questions like this because the answers are, almost by their very nature, amorphous and unquantifiable.  I want to be in therapy because I want to feel better - but how is that measured?  Is it by my ability to get out of bed in the morning?  By whether I can go out of the house alone occasionally?  By having enough of a concentration span to actually read a full chapter in a good book for once?  By going back to work?  And even if we can decide on the end measurement, where’s the demarcation line that separates ‘goal achieved’ from ‘goal failed’?

I bullshitted around the enquiry with something like I felt that I had reached a point in my life where I was ready to face things rather than hide from them (as previously noted), and that whilst I did not believe that Nexus could ‘cure’ me, I did feel that given the seemingly unanimous praise that they receive that they could at least help me deal with this one major issue, and that in so doing, I could begin to move forward in terms of recovery.

A nebulous answer to a nebulous question.

Paul felt obliged to remind me that as a voluntary sector body, time with Nexus is limited (to “about” 26 sessions, he said).  I accept that without question, in perhaps stark contrast to my experiences with the NHS, but perhaps if my time with C had only ever been agreed at a year or so, I would have felt differently about it.  Perhaps C has got a raw deal here too, because he’s the one that started to uncover all the abuse bullshit, then the poor sod was essentially forced to discharge me from his care, and now someone else is coming along to (hopefully) just pick up where he left off.  If it works, it is they – not C – that will get the credit for helping me.  I don’t know; maybe this is too much like optimism from me.  Whatever the case, although I am uncomfortable with another therapeutic time limit being imposed upon me, I do understand and accept this one.  I can have these services absolutely for free should I wish (as it happens, I will of course donate what I can, when I can).  The NHS pretends that its services are free, but of course they are not.

Anyway.  The long and the short of this very long post is that Paul is obliged to seek confirmation from NewVCB in her capacity as my consultant that the type of therapy offered by Nexus is appropriate for me.  He “see[s] no reason whatsoever why it wouldn’t be,” though, and that once they hear back from her, I will be allocated the first appointment mutually suitable.

There is, as I said somewhere above, no guarantee that the appointment nor the therapy would be with Paul; he was ‘only’ my assessor.  However, I felt that we kind of almost clicked, and I personally would be quite keen to work with him if I can.  He also told me as I was leaving that he has a particular interest in clients who, like myself, have specific mental health issues, and that he finds it hard after assessing someone to not then have them allocated to him for therapy.

So would he try and fit me in to his schedule?  Probably not specifically, because that’s not how these things work.  It is a charity after all, and for that reason I would not like to try and pressurise them into allowing me to see one specific individual as opposed to another.  Personally speaking, I’d be happy to wait a month or two for sessions with Paul to become available to me, but it seems horribly churlish to specifically request such an accommodation when they are trying their level best to get me seen as soon as they can.  Besides, their other therapists may be as or even more appropriate for me.  Though I still can’t shake off the worry of them being female.

Anyway, that was that really.  He saw me to the door, wished me all the best and smiled as he said goodbye.  I liked him, and if he is representative of the organisation in general, then I do think that there is at least the potential for positive work to be done with them.  As I said above, and as I’ve written elsewhere a million times, I don’t believe in cures to mental health problems.  Nexus won’t cure me.  They can’t even treat all of my issues, because their mere existence is predicated upon addressing one specific type of issue.  Nevertheless, that ‘one type of issue’ in my life was and is a significant one, and if someone specifically trained in the area can help me at least start to move on from the effects of it, well – that’s not a bad start in the wake of the NHS disaster that refused to provide this type of help.

* ‘Limited’?  After almost 3,100 words I can hardly describe my account of it as ‘limited’.

Points of interest that occurred to me after the composition of the main body of this post:

  1. Paul said that after the individual counselling has to finish, clients can additionally go on to a waiting list for a weekly group session.  I told him the idea of group therapy terrified me, but he said – rather enigmatically I thought – that I would “be excellent in a group”.  A opines that it’s a bit like when I did my undergraduate degree; my fellow students would gaze vapidly at the lecturer (or wall, or door, or – more commonly – they would gaze animatedly at their mobile phones), whilst my indomitable narcissism would result in considerable (and, I have to say, generally worthwhile) discussion between the lecturer and me.  Of course, back then I had some confidence and was possibly in a prolonged period of hypomania.  Things are very different now, but then perhaps the side of myself that I projected to Paul was more like the outgoing, vivacious one that hides in the dark recesses of her own mind most of the time.
  2. Unlike C, who thought I perhaps put too much emphasis on electronic friendships (and was thus, in his defence, very glad that I attended the recent Mad Up , thus making my online friends more ‘real’), Paul thinks that when you are already socially isolated as I largely am, online friendships (particularly with others who understand what living with a mental illness is like) are healthy and productive things for which to strive.  Regardless of who’s right or wrong on the issue – and I can see C’s point in this – I must say that I like Paul’s take on it better :)  Because me loves the Madosphere so much :)

Night night lovelies.  x

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