Lived Experience Forum

[CheerBear]

When there are a number of mental health issues happening, how do you decide what to focus on? It makes sense to me to focus on the underlying/core issue/s but when other things come up because of them and seem to need more immediate attention, how do you manage that?

As an example, I see my clinical psych who helps me work through some of the central issues, but it seems time consuming enough that we miss the opportunity to work through other things sometimes. One being disordered eating that can happen when things get extra tricky for me. I contacted The Butterfly Foundation today (for the first time and I am very thankful they were fab!) who gave me some info and spoke about how it could be helpful to get some specialised ongoing support, but it seems that I'd need to use my mental health care plan for it because I couldn't afford to see anyone privately which would then take my (mostly) really helpful psych out of the picture. I hit a similar barrier when looking into specific trauma support. 

I believe that specialised support could be really helpful but how does anyone access multiple supports in terms of affordability when so many specialists work privately, let alone manage how much time it would take when we are talking about multiple/complex issues? Too many professionals involved has been difficult for me before and I'm not too keen on doing that again.

And how do you decide what to tackle and when? 

Really keen to hear anyone's experiences with working through a similar issue - please and thanks 🙂

[Former-Member]

Hi @CheerBear 👋

I can read your dilemma and know first hand how difficult this can be. I found the same, too many professionals can further complicate matters at times as they can have varying opinions and approaches. And the accumulating costs can be astronomical and out of reach for most.

I am not seeing a psychologist presently, mainly due to not finding a suitable one for the reasons you described. But I am on the look out for one.  I did once see a good clinical psychologist whom specialised and covered several mental health areas, such as child abuse trauma, anxiety, depression, sexual abuse and other areas of expertise that did cover most of my issues. But you already have a psychologist whom you are happy with so this may not suit you to pursue.

In regards in deciding to tackle what when - for me it would of been tackling first the most debilitating symptoms that was effecting me and my day to day life; so I could function better in the now, no further damage could occur and i could make more progress moving forward in my life.

I did delve into the causes with psychologists and psychiatrists for a short time which was extremely painful and hard. Once I covered this in therapy addressing it briefly I left it there, as for me personally it was best left in the past as it was continually too triggering and not helpful after awhile. Initially it helped release the grief over what happened - that was beneficial but too much delving caused me to relive it over and over....that was adding to my trauma. So it can be a very individual experience.

I found working on the strategies/thoughts patterns/actions that helped me emotionally and psychogically to move forward with my life was the most nessecary to tackle first.

Hope everything works out for the best for you soon @CheerBear

[Phoenix_Rising]

Hi @CheerBear,

Ideally what should happen (and hardly ever does in my experience) is that the psychologist should develop a solid case formulation and from there, then develop a treatment plan. This is why I kept asking (and not getting) a case formulation and treatment plan from (A). 

When someone has lots of muddles, the muddles are very rarely unrelated. More commonly, they are all intertwined and tangled up together. 

What I was taught at uni (and thus I assume every psychologist was taught) was that the first step is to get a really comprehensive picture of what is going on for the client. Then you can identify the precipitating and perpetuating factors (and also protective factors). From there, you can develop a treatment plan. 

So, for example, if disordered eating was identified as being due to extreme stress, then figuring out how to deal with the stress would in turn address the disordered eating. In contrast, if you focus on the disordered eating without dealing with the stress, it is unlikely to be helpful, in the same way that constantly cleaning up an infected wound without treating the source of infection isn't that helpful. Does that make sense? 

I totally agree with you regarding the time and cost factor! Right now, I'm really not sure how TTT is going to help me unmuddle my muddle at the rate of 50 minutes per week. I still very much feel like I'm trying to bail out the Titanic with a teaspoon - and since my turtle whisperer dumped me, the Titanic is already  99.5% underwater. 

[Former-Member]

Hi @CheerBear@Phoenix_Rising

It was very interesting what @Phoenix_Rising wrote and got me thinking on my own personal experiences and my daughter's. Yes elimating the stress that causes mental anguish can be helpful. For i.e. if a person is not eating because of worry, anxiety, low self esteem or body image than dealing with the latter causes would better help the eating problem in the long term. But that can take a long time to sort out and sometimes there are no quick fixes for the causes or the stress that is to blame - so it is nessecary then to deal with the symptoms first in order to function better in the now and not endure more harm physically and mentally whilst working the psychological or,physical stress that has caused it.

For example my daughter was raped and abused mentally in a domestic violence situation. She was only very young and acting against our guidance at the time (being 18 we had no control over her choices). She started to self harm, would not eat and was being violent towards others as a result of the stress of the assault/trauma.

When she went to head space they tried to get her to talk about the assaults and traumas in order to fix her anger outbursts, depression, anxiety, violent and self destructive behaviour. In counselling they said anything else was a bandaid solution. They asked her a lot of questions in counselling which made her relive the experience and this distressed her to the point she flew into a rage. She could not handle it and was not ready.

It then became necessary for her symptoms to be controlled first as it became debilitating for her to function in every day life, to hold down a job and to even address the stress that was causing it rationally. The anger issues could of seen her in jail. So she had to deal with it first before any further damage was done. Too much damage had been done and any dealing with the cause/stress that was triggering her symptoms could take a life time to heal if at all. So she had to deal with the symptoms - the low self esteem/worth, anger issues and mood swings that resulted from the stress of trauma to be able to move forward with her life.

Its never black and white and very individual to ones situation.

She is now, 5 years lately, only ready to address the assault and issues that caused it - but will only talk to me as she trusts no one as a result. She has improved greatly and still refuses to see a psychologist to talk about it. She does work in her anger issues. And she has a limit to what she reveals to me about what happened - otherwise if I get her to talk too much about the stress she can become Self destructive and depressed again through reliving it. It is a work in progress. So as you can see it depends on the severity of the mental anguish and the situation to know what issue to deal with and when.

[Phoenix_Rising]

Hi @Former-Member,

Yep, definitely very individual. That is why a MH professional needs to do a case formulation and treatment plan. I certainly wasn't suggesting that it is always most appropriate to deal with intense trauma stuff before addressing other things. I was just giving an example. I'm sorry if it came across as suggesting that addressing icky trauma stuff is always a good idea as a starting point. Indeed, DBT very much focuses on teaching distress tolerance and emotion regulation skills before going near any trauma stuff. I'm glad to hear your daughter is doing better now. 

[Former-Member]

Thank you @Phoenix_Rising for your kind words. I wish my daughter could do DBT as I think it would help her tremendously and it was advised by a psychiatrist she saw when she was scheduled. There is not a private hospital near us near us that offers this, my daughter would of had to have travelled a long way to have received it and this put her off unfortunately.

Such a shame as I think she would improve even more if she had tried it. She controls her anger a lot more and can hold down a job etc, but her self esteem is still very low she is very introverted. I saw that you are doing a DBT thread - I will pop over and have a read as it sounds interesting. Thanks again 

[outlander]

i dont have anything to add but im interested in reading along

[CheerBear]

Will come back and reply properly when I can but wanted to say thanks for your replies Enigma and Phoenix_Rising. Definitely some things to think about 🙂

Outlander ❤

[Mazarita]

Hi @CheerBear and everyone, 

I've been seeing mental health professionals for over 25 years (mainly psychiatrists, some psychologists and others, such as support worker from Phams). Therapeutic fashions have come and gone in that time and I have been involved in a number of different approaches, some structured, some much less so.

These days I approach therapy as a means to improvement, not cure. Hoping for cure was a recipe for frustration and unhappiness in my case, whereas seeking and finding improvement in a more wholistic way allows much greater assistance to me.

This is how my current psychologist sessions go:

. My psychologist and I enter room and she asks how I am and have been since last seeing her

. I respond spontaneously and the session proceeds in a natural conversational flow from there.

This seems an unstructured kind of therapy and it is my preference. Because we are focussed on 'being in the moment' with each other in the session itself, it's hard to predict what exactly will get discussed on any given day. All my sessions with this psychologist so far have involved discussion of both obvious behavioural issues as well as deeper psychological issues. Sometimes our discussion goes into the area of social work. In most sessions, we laugh a fair bit, which I think is great. I feel I am getting a lot from these sessions, without it being highly intellectual, theoretical or structured. I feel a trust in the deeper mind's ability to 'throw up' things that need talking out in my sessions. And I think this may have a longer term benefit to my overall quality of life.

I wonder if this makes any sense or is just an odd personal tangent. Either way, thanks for reading and trying to make sense of me. 

[CheerBear]

Thanks heaps for sharing and replying to those who have. It really helps to hear different perspectives and experiences.

@Mazarita - it is so great to hear how helpful you find your psych 🙂 At my last appointment with my psych, they said that their approach with me was a 'see what CB needs today' one and that they don't have any kind of long term 'plan' for our work together, which is unusual for them, and sounds a bit like your psych's approach with you. In so many ways it works well for me too but in other ways, I get frustrated as I want to fix things not learn to live with them. I wish I knew how to be more ok with improvement, as my determination to fix it all seems to be to my detriment sometimes. What you said makes heaps of sense - thank you for adding your experience and perspective 🙂

@Former-Member thank you for your reply and for sharing your experience too. I am very sorry to hear that your daughter and you have been through what you have and can hear the huge impact it has had on your lives. As far as talking about trauma stuff, I believe that sometimes talking about things when you're not ready or when you're pushed too hard or too much can cause problems, as it seems you experienced. The extent of what my psych knows is little more than as much as you shared in your post about your daughter (as in not much of anything specific). In some ways it is really 'safe' and in other ways it feels like tiptoeing around things. I like the idea of working on what is the most debilitating right now in order to move forward.

@Phoenix_Rising - thanks for replying too. What you mentioned makes sense also and is what I have been taught in a way, though not in psych. Lots of muddles can be so muddling 😞 In terms of the issues being related, I can identify how and why mine probably surface, how they play in to each other, how they make each other bigger/harder etc. which is great, but it doesn't change it. It can add big frustration as it's like I am watching what is going on but not being able to stop it. I have a feeling you may experience some of this too.

Try as I might, I have no ability to control what could happen (none of us do really - I get that) and where I frequently find myself is that what could happen is terrifying and so difficult to live with that it makes living very hard. I know what could happen because I have experienced what did happen, as have all of us with trauma histories. I have one little piece of paper left to protect us from what could happen and I won't have that very soon. It was a worry I had been managing (mostly) and mostly keeping to myself, until now when it is very close to happening and the reality of what it could mean, has hit me. It's driving big fear and a sense of a huge loss of control, making the whole world and everyone in it feel scary and unpredictable. With that, out comes not-so-helpful thoughts and behaviours probably in a useless and counter-productive attempt to regain some control and make the world feel safer. I need to address the core aspects of being scared and of not being in control of my life, in order to stop myself from self-destructing, but I also need to stop the self-destructing so I can get to a place where I am able to address the issues that cause it all - hello scrambled brain :S

I can very much relate to the titanic and the teaspoon. When I think about the things that play into my sinking, I don't know where to start getting myself back up again, and my attempts to do so often seem to not be enough to stop it anyway. Maybe that is because I always have "but even if I can get the titanic up and going again, there will always be icebergs that could take it down", running through my head. I don't know how to be ok with not being ok about that. I feel so frustrated (and sometimes hopeless) thinking about what I want to do this year but knowing that it could all come to a grinding halt once again. And that there's little I can do to stop that if it is what is to be.

Apologies for the essay and thanks to anyone who read it.

I have decided to start with my GP on Monday to work out if there is anything at all that I can do right now to break the vicious cycle that happens, particularly around sleep and eating. Maybe my focus for the short term is better given to that, and once that's sorted I can work out where to from there to stop it happening. Whether that be a new approach with my psych, a new psych, finding an additional support person etc., - I can work it out once I have self-destruct under control (control - that seems to be what it's all about 😉 ).

Thanks oodles to you all for sharing and listening. It helps to be able to talk it through and make some sense of it.