Wednesday, 25 March 2020

Trauma Focused CBT: Session Ten

(TRIGGER WARNING: Covid-19, Mentions of abortion, trauma, domestic abuse, physical, psychological, and sexual abuse)

In the week leading up to this therapy appointment, a lot had happened in the news. Coronavirus became a pandemic, hundreds of people dying from the virus, places (like cafes, bars, cinemas etc) closing, people urged to stay at home unless needing supplies from the supermarket, and lockdown was looking very likely. It's a very worrying time for everyone, even without an anxiety disorder on top.

Amongst other things, I have Generalised Anxiety Disorder, Obsessive Compulsive Disorder, and Post Traumatic Stress Disorder. I have found these have all flared up in different ways. I worry about everything more, I'm doing my checking rituals more often, and I have these thoughts that I am unsafe and something really dangerous is about to happen to myself or my loved ones. As well as this, my flashbacks have increased.

I am coming to the end of Trauma Focused CBT for my traumatic abortion specifically. My therapist and I have come to realise that my abusive relationship with an ex brought up traumatic symptoms for me too, but this lot of therapy is nearly over so I'd have to re-refer myself or find some other therapy or counselling to help.

As for the traumatic abortion, I think my PTSD symptoms have lessened slightly (overall, I mean) but the physical pain etc from it still crops up as vivid flashbacks. I may need the odd couple of sessions to give me tools to work on my feelings about this, but I think I am coping well enough to deal with this trauma generally, and use the skills I have been taught for this.

My therapist and I did talk about the abusive relationship, and how memories of that affect me now. It was a long conversation with lots of questions about how my ex partner treated me, how I reacted, and how I feel about it now. I spoke about a few things he had said and done, that affected me badly. I know that I'm not coping well with it, I do get intrusive thoughts, flashbacks, bad dreams etc and I find it very hard to trust men who are interested in me.

This relationship started just as I'd had my abortion, and I believe I was looking for a fresh start, as well as someone to look after me and support me. (You can read more about my abusive relationship here, but I will mention a few things that he said and did.)

My ex partner was very nice and gentlemanly at first. He bought me flowers, took me to nice restaurants, said lovely things and didn't push me to do too much. This soon changed though. I thought he understood that my abortion had been very distressing for me and this is why I was so depressed and quiet. In later arguments, he would bring this up and tell me that I (and others) should've focused on how he was feeling and paid attention to him more.

I found that everything was ok, as long as I agreed with him and everything was on his terms. As soon as I didn't, or they weren't, he would be cold, callous, and cruel. He would push and push me to do things I didn't want to do. On one occasion in particular, he tricked/forced me into doing something sexual that I wasn't comfortable with. Straight after, he acted as if nothing was wrong. I was left feeling confused, violated, and as if I was overreacting.

He would use the old cliche "you'd do this if you really loved me".

As well as this, he was psychologically controlling, he gaslit me, and tried to keep me away from my friends. It was as if he wanted to control any situation we were in. It took me a while to realise that he was so toxic. I tried to break up with him at one point, and he wrote me a long letter to supposedly apologise and promise to change. I foolishly took him back and things had unfortunately not changed.

When we did finally break up, we would still argue, and at one point he followed me back to my student house to "talk". I didn't want to, but he wouldn't take no for an answer (a running theme in our relationship...). I tried to walk away from him, but he grabbed me hard. At this point, I was scared that he would hit me. I couldn't get away because his grip was too strong. It was only when my housemate walked by and saw, that he let me go and ran off. I was understandably really distressed and it took a while for me to calm down. 

I told my therapist about this (amongst other things that had occurred in our relationship) and she confirmed that my ex was very abusive and toxic. She also believed that although he made me feel vulnerable, I was actually very strong for arguing back despite my fears about the consequences.

She told me that although these sessions of CBT were for the abortion specifically, after a break I could get re-referred so we could focus on this abusive relationship. She did recommend I contacted Women's Aid though, as they are apparently very good at providing support to do with domestic abuse. I could even get some counselling from them.

After this telephone therapy session, I felt very uncomfortable, unsafe, and as if I was being violated all over again. The psychological control was personally very hard to cope with, but I seem to be most affected by the sexual abuse I experienced. I feel so uncomfortable in my own skin, as if I want to scrub it all away?

I have decided that once these therapy sessions are finished, I will take a month or two's break, then I will contact Women's Aid to see what they could offer. I guess any counselling will be done over the phone for now (because of Covid-19 restrictions).

In the meantime, I aim to use my time to distract myself with games, movies, cross stitch even. I also want to be very kind to myself and as supportive as I can be towards my friends and family.

Resources

Lockdown: https://en.wikipedia.org/wiki/Lockdown

Symptoms of PTSD- What are flashbacks?: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#WhatAreFlashbacks

Amys Mystery Illness- I'm a Survivor: https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

11 Warning Signs of Gaslighting: https://www.psychologytoday.com/gb/blog/here-there-and-everywhere/201701/11-warning-signs-gaslighting

Women's Aid: https://www.womensaid.org.uk/




Wednesday, 18 March 2020

Trauma Focused CBT: Session Nine

(TRIGGER WARNING: Abortion details, domestic abuse, sexual abuse, psychological abuse, mental health stigma)

"Double Trauma"

I'd been in quite a good mood; leading up to this latest session. At baseline, my moods have been stable and rarely very low. I'd even had some days where I could say I felt happy, or at least calm. I'd not reacted so severely to things that usually upset or anger me either. Generally, I think I'd been coping well.

I've been feeling that I'm coping with people's attitudes to abortion because I finally believe I made the right decision at the time. The thing I've been struggling most with is the physical side of things. The blood, tissue etc, distressed me because they were so graphic and result in such vivid flashbacks.

At this latest session, I explained all of this, and my therapist was pleased. She left it up to me to talk about what I wanted to, and the abortion appointments cropped up in conversation. She asked me some in depth questions, in order to gently expose me to my most feared memories. I coped, but I did get very worked up and shaky as I explained everything.

When asking about support from friends etc, my abusive ex partner came up in conversation. He appeared to be supportive and gentlemanly at first, but only when I was doing what he wanted/agreeing with him.

When things didn't go his way, he would be very cold and controlling. He made everything about him, rather than considering my feelings. He made digs in conversations and arguments. He also forced and tricked me into doing things he wanted sexually. I found that he expected me to do what he wanted because he was the virgin and I was experienced; so it was (in his eyes) my "duty" to teach him and let him experience new things with me.

I described a time he tricked me into doing something I didn't want to do, then carried on as if nothing had happened. I felt violated and confused. Did I let him? Was it my fault or his? Was this normal or abusive?

I got quite distressed when describing this relationship, and my therapist said it seems like being in the abusive relationship straight after the abortion made this a double trauma for me.

I thought about it a bit, then agreed. I thought I'd moved on from it, but it still affects me now and I'd buried it for a while.

Overall, I've been coping with my trauma from the abortion, but I have not really dealt with the trauma from the abusive relationship. I did feel I had to hide it from people for a while, in case I wasn't believed. My ex partner made sure lots of people thought I was "crazy" when we broke up. He called me many different names and turned people against me. Even when we broke up, he wanted to control some of my life.

The friends that stayed by my side were invaluable though. They defended me, and made sure I was ok. I thought I was at the time, but years on I realise how it has affected my trust in men especially. I feel scared to disagree or say I'm not comfortable doing certain things. Hopefully, in time, I will be able to be more assertive and be part of a more equal partnership.

Thankfully he's also halfway across the world from me now. I just wish I could move on from this, but I know it will take time.

I was hoping to finish my Trauma Focused CBT sessions very soon, but I think I will need a few more with a focus on this.

Friday, 6 March 2020

I Decided to take a Social Media Break

As of last Monday, I decided to take a Social Media break.

I'd been scrolling on Facebook and Twitter particularly, and had noticed symptoms of my mental illnesses flaring up, as well as a general sheer drop in mood. The kinds of anxieties I had were about friends. I'd found that not many people were replying to me and some were replying in a more blunt way than usual. Naturally, I thought that they were finally getting fed up of me, and as much as I tried to believe that maybe they were having a bad day/week etc themselves, I couldn't help but place the blame on myself and criticise myself for "pushing them away".

The more I ruminated over this, the worse I felt. That, coupled with my worries over getting more ill and having no help from the Community Mental Health team, meant that I was heading towards crisis point. I broke down in my last CBT session and stayed that way for days afterwards. Eventually I decided I had the choice of either returning to a very dark scary place in my mind, where I actually am pushing everyone away and making dangerous decisions, or I could make a vow to change my mindset.

Of course, this is easier said than done, but I was at a point where I could "catch" myself before I went over the edge, At this point, choosing was difficult, but possible.

I decided that because the Community Mental Health Team wouldn't save me, I had to try and save myself. I started with a social media break. I needed to stop scrolling through my timelines; letting everything get to me and being bombarded with bad news and more people to "cancel".

I have taken social media breaks before, but usually this was with the ulterior motive of seeing if anyone noticed and would message me. I often feel like people would barely remember me if I was gone. I also worry no one sees me as close a friend as I see them.

The main reasons for this break were to have time in the "real world", take time for myself to reassess how I feel about friendship, reassurance, and myself. I need to become more self compassionate and self reliant especially.

Although I wasn't necessarily expecting messages, I did get some from a couple of friends. I've missed talking to people (barely anyone texts me these days), so getting some messages has helped.

I've also recently been reading a book called "The Compassionate Mind" by Paul Gilbert. I've been finding it very useful. I can relate to a lot of things in the book (my mindset, things I worry about, things I do etc) and it has a lot of exercises I can do. These exercises aim to conjure up self compassion and compassion for others. It involves a lot of meditative mindfulness tasks too.

Since reading this book, and completing some of the exercises, I have found I've had times where I feel peaceful. I still have a long way to go, but I am doing better than I was. I think I've managed to pull myself further away from a crisis; which is such a relief.

In case I do get to crisis point again, a friend helped me to plan what I could do. This would involve letting my parents know so they could get in touch with the GP who I find is most helpful for my mental health. He would possibly see me for an urgent appointment, and I would get advice and/or emergency medication (depending on what he felt was appropriate). Alongside this, I could also talk to trusted friends and ring my local mental health helpline. They may be able to advise me as to what to do, or help me calm down and think more clearly. The problem with being at crisis point is that you often don't feel in control of your thoughts, feelings, or actions. It can be a very risky time and it is important to have a plan that is easy to follow.

For now, thankfully, I'm not at that point though. I also don't feel as worried about friends who don't contact me much/at all. I know that the true friends will stick by my side and it is important to concentrate on them, as well as being reliant on myself.

I will continue to read the compassion book and complete the exercises every day. I seem to be using it as a guide, and maybe that is what I need right now. My next CBT session is on Monday, and I'm hoping I can give some positive news to my therapist then. I do not feel I made much progress in the last session, but I think I needed to get to that point in order for something to change within me.

So right now, I can't say I'm exactly happy, but I'm OK and I think I'm making slow but steady progress. My next blog post will be about my next Trauma Focused CBT session.

Wednesday, 26 February 2020

Trauma Focused CBT: Session Eight

(TRIGGER WARNING: Mentions of abortion, self harm, and details of attempted suicide)

I felt very on edge, leading up to this latest appointment. I think it was for various reasons. Firstly, I was waiting on results of some scans and a possible follow up appointment with my Rheumatologist. Secondly, it'd been a while since my previous session, and I felt I hadn't done enough homework in that time. Thirdly, I'd been very down recently and felt I'd lost some of the progress I'd made with my PTSD. There were probably other reasons too, but the above states the main ones.

As expected, I scored highly on the Anxiety, Depression etc questionnaires. My moods had affected my behaviours and functioning, and they weren't helping my ability to keep myself occupied and maintain relationships either. I felt disappointed in myself and as if I'd failed my therapist. She asked me how things had been recently and if anything had happened in particular.

I explained that I had been very low and anxious recently, about various things including friendship. I felt very alone and distant from people I loved. I'd been very quiet recently and have felt that even when I have interacted with friends etc, I'd been saying all the wrong things.

My therapist wanted me to see how my moods were linked to the trauma from the abortion. I told her how I'd spoken to a friend who'd helped me through the abortion, and one who had an abortion herself a while back.

The main topic, surrounding my abortion, that I spoke about with the first friend. were the attitudes experienced from the nurses involved in my care, as well as the man who would've been the father of my child, and the new boyfriend I had at the time. I felt I'd had very little support from them, and judgement more than anything. The nurses judged my resulting in becoming pregnant, and my decision to have the abortion. The father-to-be also judged my decision to have the abortion, and treated it as a tragic loss (even lighting a candle to "mourn" when we were speaking via video call online). The new boyfriend judged my sexual history as well as my becoming pregnant, although he was all for me having an abortion (I don't think he wanted children).

When we spoke about the father-to-be, we discussed what might've happened had I carried on the pregnancy. My friend believed that he probably wouldn't have stuck by me, especially going by our on/off relationship. He seemed to find any excuse to dump me to be honest. The more I think about him, and our relationship, the more I realise that maybe he wasn't the right man for me after all. I think part of me never really got over him, and even saw the pregnancy as a bond between us (even after it was over). I feel I have moved on from him, if not the trauma however.

The friend I spoke to, who had experienced an abortion too, had similar judgement from the nurses involved in her care. In time, and with a lot of therapy, she had managed to move on as much as possible, and did not find memories of this traumatic anymore. I found it eye opening that the nurses had been just as unprofessional towards her, and I felt angry and upset for her. To know that she could move past this gave me hope though. Maybe I could do this too, in time?

We spoke about how I hadn't gone into much detail about the abortion, and that I find it hard to face. I'm still avoiding a fair amount of things, including carrying on conversations about abortions, reading views on them etc. I explained that I was scared of being badly triggered and becoming very unwell again as I felt I wouldn't be able to get any help.

I then talked about how my thoughts still go to self harm/suicide when I find myself in a situation I cannot/easily get out of. She asked if I remembered a time in the past when that happened. We spoke about a time I was threatened with sanction on the Work Programme (Part of Work Related Activity for Employment and Support Allowance), for a situation I could not help. Basically, at that time I was too anxious to travel places on my own. My dad worked shifts at that time, and his shift patterns changed so that he would not be able to take me to appointments with the Work Programme. No one else I trusted could take me, so I suggested having telephone appointments, but was refused. Being in this catch-22 situation, worrying about loss of income, I became so suicidal I nearly ran into traffic.

I got very upset in this therapy session, as I explained how scared I am of going back to that point.

She asked what would happen if I got to that point. I explained about my experiences with CMHT assessing then discharging me because I'd already had help from them in the past, and they felt there was nothing more they could do. I also told her what the A&E Psych Liaison team had said (They described me as a square peg, and the CMHT as a round hole. This implied that I was simply too different to be helped by them) and that I felt the door was permanently shut to me even though I couldn't understand why I should be any different to anyone else when I need that sort of help.

The session came to an end soon after this, once I had calmed down. My therapist gave me homework to be kinder to myself, read bits of the self compassion book she had recommended (I can't remember the exact name, but it is by Paul Gilbert) and try to talk to friends more directly.

I still feel affected by this session, but having a good cry and venting my fears has helped. I know that I need to make a change, for the sake of myself and my loved ones. I need to be much kinder to myself; practising self acceptance and forgiveness.

Thursday, 6 February 2020

Trauma Focused CBT: Session Seven

(Trigger Warning: Mentions of Abortion, Stillbirth, and Miscarriage)

I felt quite down leading up to, and during session seven. My homework was to pick some of the feared situations from the list I'd made in my last session . I decided I would try to look at some pregnancy scans on Facebook, as well as watch some story lines on television, of stillbirth and miscarriage. I was also to carry on using the term "Abortion" rather than "Termination". As well as this, I was to keep on journalling and noting down how putting myself in these situations made me feel and how I coped with that.

I find using the term "abortion" isn't so fearful now. My feelings about the term are more the way someone would react when a word makes them cringe (e.g. "moist"). For the record, this does not mean I am against abortion, it's just that the traumatic one I had makes certain things affect me in different ways. So saying the word brings me back to that time, but not so intensely that I panic and get particularly triggered.

I can also cope better with seeing pregnancy scans. Before I exposed myself therapeutically to this, I found being faced with any pregnancy scan triggered me and would bring back flashbacks of being told I'm pregnant and feeling scared about what was to come next. I can separate other people's scans from my own now, and am not brought back to that time so uncontrollably.

Watching story lines about any kind of baby/fetal loss is still very difficult though. I'm forcing myself to stop avoiding these story lines, or zoning out (although I do still find myself dissociating sometimes). Stillbirth isn't as triggering, although it upsets me as much as it would upset anyone, if not slightly more. The physical side of miscarriage and the attitudes towards abortion that you see on medical dramas for example can be very triggering however. It can trigger flashbacks of the most graphic parts of my traumatic abortion; including the sickness and pain. The attitudes also remind me of the judgmental attitudes of some of the nurses I saw at that time. I was made to feel like an irresponsible teenager. I was also made to feel guilty by the potential father (he lit a candle to "mourn our loss") and made to feel like a burden by my partner at the time, in subsequent arguments around this subject.

I explained all of this at my latest session, and my therapist helped me to understand that although I had made the decision to have the abortion, the attitudes of those around me and the physical pain etc was not my fault. I had made the right decision for me at the time, even if I thought I may have coped if I'd kept the baby. It still would've affected a lot of my life.

My next piece of homework was to go through more feared situations. This time, I decided to try and talk to the best friend who supported me throughout, about my abortion. I also decided, if appropriate and carefully planned, to talk to a friend of mine who has also had an abortion. This would hopefully help open me up to other perspectives, their views on what I/they went through, and importantly, to feel less alone and more connected with people who have been through similar.

So far I have managed a short talk with the best friend; where we mainly spoke about the attitudes of people around me at the time. I found this very helpful, validating, and eye-opening. I won't go into much detail but we discussed the potential father and how flaky he could be when it came to supporting me. I hadn't fully realised this at the time, but I know now that it was true. I was so in love with him, but I'm glad to have moved on. I don't know what the future will bring, but I do hope I find the right partner for me, who would like to have children too. I also hope it is not too late to have children by the time I am ready.


Resources

Amys Mystery Illness - Trauma Focused CBT: Session Six: https://www.amysmysteryillness.co.uk/2020/01/trauma-focused-cbt-session-six.html

Wednesday, 15 January 2020

Trauma Focused CBT: Session Six

(Trigger Warning: Mentions of Abortion, Miscarriage, and Stillbirth)

I went into session six feeling quite positive, after seeing a friend the day before. I'm finding making plans with friends gives me something to look forward to, and distracts me from things. I'm trying to talk about abortion more with close friends too (and actually use the term "abortion" rather than "termination", in order to face my fear of using that term).

My last piece of homework for CBT was to list my 10 most to least feared situations related to my trauma. For me, these include saying the word "abortion" out loud, looking at a pregnancy scan, conversations/television storylines about other people's abortions, miscarriages, or stillbirths, conversations about my traumatic abortion (especially details), and hearing an anti-choice person's opinion of abortion. The latter one is my most feared as it challenges a very personal decision and puts the blame of my trauma on me.

I have recently managed to say "abortion" out loud and pregnancy scans don't make me feel as down now. I can't totally explain why certain things trigger me, but some make more sense than others I suppose.

I decided to focus more on the positive side of things in this latest session, as I wanted to remind myself what I'd actually achieved and I wanted to see for myself if I had progressed. I'm definitely taking baby steps, but there is a definite improvement in how I react to certain things. My therapist was so pleased to hear this, which made me worry that she would make this the last session (I'm so used to mental health professionals cutting off support at the slightest hint of progress) but thankfully she does want to see me again and hasn't even mentioned bringing these sessions to an end.

My homework for the next session is to go through 2 or 3 of the "feared situations" and try to face them. We discussed which ones I could manage, and which I would struggle too much with. We decided that I would watch a storyline about baby loss or abortion, look at a pregnancy scan, and try to talk more about my abortion. So far I've managed to do these without too much panic. I'm finding it so helpful to have learnt skills to help cope with the feelings I have when exposed to these situations. If I'm properly triggered by something, it's very hard to use the skills (Safe Place, Breathing Exercises, Grounding etc) but if I can "nip it in the bud" so to say, then I can avoid or minimise the triggered feelings.

So overall I'm finding I am very slowly progressing, but I do still need at least a few more sessions of therapy. I'm being realistic too. My therapist and I agree that I'll never be totally desensitised to talk of/memories of my abortion, but I will be able to get to a point where I can still function with these things on my mind. Maybe I can even lessen/stop the flashbacks I get.

My next session is on Monday, and I will try not to leave it so long before I blog about it.

Resources:

What Does It Mean to be Triggered? https://www.verywellmind.com/what-does-it-mean-to-be-triggered-4175432

Amy's Mystery Illness- Trauma Focused CBT: Sessions 3-5 https://www.amysmysteryillness.co.uk/2019/12/trauma-focused-cbt-sessions-3-5.html

Symptoms of PTSD https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#b


Monday, 30 December 2019

Trauma Focused CBT: Sessions 3-5

(Trigger Warning: Multiple mentions of Abortion)

I'm sorry for my lack of posts recently. A lot has happened generally; including in my personal life. I've been feeling very down and anxious, as well as angry, upset, and irritable. It's made concentrating on blogging pretty much impossible. I think I'm starting to come round now, and at least try to keep up to date with my blogging.

I have had about 5 sessions of Trauma Focused CBT now, and although I don't feel like there's been much/any progress yet, I do feel positive that this is the right type of therapy for me and I will find things easier to cope with in time. I'm not sure how many sessions of this type of CBT I'm allowed, but I'm hoping there are at least a few more!

The sessions have been difficult, but productive. I have had times where I could talk in detail about the abortion, and times where I want to talk about anything but. For the times I am getting triggered/overwhelmed however, there are tools I have obtained to deal with it. I will explain some below:

Grounding: This is very useful for when I dissociate. A type of grounding I use, involves the 5 senses. When I find myself dissociating, I have to try and find/describe something I can see, smell, hear, touch, or taste. This reminds me that I am physically here right now, in the present time. When dissociating, I can often feel like I am not real, my body is not in the physical world, I'm not in the present time even. Grounding helps me to remind and reassure myself that this is not true. I am here, the past is in the past, the trauma I have been through is not happening now etc. I won't lie, it's not easy and it does take time, but most of the time this technique works.

Safe Place: This visualisation technique is used for when I am overwhelmed and panicky after talking about my trauma. A safe place is somewhere in my mind that can be anywhere; fictional or real. Personally, I like to visualise a sandy secluded beach in a warm climate. I can visualise this on my own, or my therapist can guide me to focus on certain things about it (e.g. the sight of the waves, the smell of the sea, the feel of sand between my toes etc). Performing a gesture such as clenching an object or my fist can help bring me to this place too. I clench my fist and imagine I am grasping a handful of warm, soft sand. Like grounding, this is difficult and takes time to focus on, but it can give me a short break from thinking about my trauma. This also slows down my breathing, heartbeat, racing thoughts etc.

Mindfulness: I find having a guided meditation video/audio recording, or having my therapist guide me, helps with this. I can use this when I'm feeling overwhelmed and panicky, or even when dissociating. It brings me back to the present time and helps me to focus my attention on things happening, stimulating my senses etc in the here and now. During mindfulness meditation I may be asked to focus on how my chair feels against my legs or back. I may also be asked to focus and describe the sounds in the room. If I have any thoughts about the traumatic abortion, instead of fighting them, I need to accept they are there, but try to shift my focus back to the present and remind myself that the trauma is not happening anymore.

I have been working through my PTSD booklet as well, and have got up to the part where I list feared situations, from most feared to least feared. For me, feared situations involve conversations about my abortion, someone else's abortion, using the word itself, stories about baby loss, and pregnancy scans. I may go into this in detail in the next CBT based blog post. The point of this task is to slowly expose myself to each of these situations. As you can see in this post, I am trying my best to use the word "abortion" instead of "termination", because this is the scary word for me. To me, it sounds more harsh, although I couldn't really explain why. It's not healthy to avoid using a word however (unless the word is a slur of course!) so I need to train myself to feel less scared about this.

My next session is coming up in about a week's time, and we will be focusing on the specific fears I have. This will be a difficult session, so I may need a few days to process things before I blog. In the meantime, I hope everyone's Christmas went well and the New Year brings good things.