Saturday, 11 April 2020

Trauma Focused CBT: Session Eleven

(TRIGGER WARNING: Description of medical abortion, pregnancy, and sexual domestic abuse)

Although my moods (mainly due to Coronavirus) have been fairly bad, my moods overall (and specific to my abortion trauma) have improved. I thought this session might be my last one.

I was very overwhelmed on the day of this phone CBT session, as I'd been catching up on my homework. The things I needed to do for this session were to watch a programme about abortion, and to look up information about the process of medical abortion.

The week before this session, I'd seen a news piece about the change in abortion laws in Northern Ireland. From what I remember, it'd been legalised but the problem was that there was a distinct lack of services that actually offered abortion treatment. A woman in the piece had to travel to England for her surgical abortion and if I remember correctly, she'd been under anaesthetic but rules meant she had to travel back home that evening. It sounded extremely distressing. I thought I'd dissociate straight away or I'd avoid the news item altogether, but I found myself fixated on it. I did dissociate afterwards, after getting quite upset. It did stay with me for the rest of that day, even when I'd grounded myself. Even though this was pretty bad though, it wasn't as bad a reaction as I expected.

The day of the session, I'd been on the BPAS (British Pregnancy Advisory Service) website, looking through the process of medical abortion specifically (When I was 19, I had a medical abortion at 5 weeks pregnant). I did find it very upsetting and particularly triggering when looking up the physical effects of termination. It was very descriptive and brought on flashbacks of my trauma.

My scores on the PHQ-9 , GAD-7 , phobias and lifestyle effects questionnaires were a little better than the previous fortnight, so my therapist was pleased about that. I did tell her that I felt I reacted less extremely to topics of abortion too, although I still got triggered by descriptions of the physical effects. She asked if there was anything else I needed to talk about or ask that day. I explained about what happens when having a medical abortion. The first visit for the treatment itself, you take one oral pill. The second visit, you are given 6 vaginal pills to take. According to the BPAS website, you are only supposed to take 4 though (I said I think the spare 2 were for if any fell out). When I went though, I got confused and took all 6. Because of this, I was now worried that I may have caused complications and maybe that was why I was so ill/in horrendous pain so soon after treatment and for so long.

I got a bit worked up, when talking about the physical side of things. I also blamed myself a lot for doing things incorrectly. My therapist said I don't need to be so harsh on myself though. On the second day of the abortion, I had a lot of information to take in, and it was no wonder that I couldn't remember everything. It was a really distressing time for me throughout. The nurses should've been more compassionate and clearer with their instructions.

My therapist asked if there was a number I could contact BPAS from, in order to ask about what happens if I take all 6 pills instead of just the 4. Of course she couldn't give me medical advice, but maybe someone from BPAS could tell me, or signpost me to an organisation that could advise. I told her I wasn't sure if 11 years post abortion was too late to ring them, but we decided it would be worth ringing. Even if they couldn't offer me support, they most likely could signpost me to somewhere that could. 

After this discussion, my therapist asked about the abusive relationship I'd been in, after my abortion. She wanted to know whether I felt I needed help with that too. I said I reacted to storylines, information etc about it in the same way as I used to, about the abortion, so yes I did need help. I explained how the sexual abuse affected me the most, and I found that I would feel like I needed to scrub myself "clean" when thinking back to it. I reminded her that she'd told me to contact Women's Aid for support. I told her that I'd be calling them in about a month, as I felt I needed at least that much time for a break from therapy. I felt I'd be overwhelmed if I went from one form of therapy, straight to another, especially when discussing such traumatic things. She agreed that this would be a sensible idea, and that I needed time to process things, carry on with practising the skills I'd learnt etc.

At the end of this session, we booked me in for another phone session. As I had improved so much and I felt that I'd had enough therapy recently, I asked whether this could be the last or penultimate one. I explained I felt I am starting to depend less on therapy for this particular trauma, and I have improved enough to cope with the homework on my own. The therapist was fine with this, and was pleased that I felt this way.

I feel really pleased too. Not just because of improving so much, but because of how helpful and supportive my therapist has been. She has been encouraging, empowering, and has never rushed me. We have focused on my strengths as well as my struggles, and any homework etc has been discussed between us (mainly led by me to be honest) instead of her pushing me to do things I don't feel ready for. I would recommend this therapist to anyone struggling with trauma.

My homework for next session is to call BPAS and ask about the pills. At least then I won't be dwelling too much on the mistake I made in how many pills I took. It could be that it wouldn't cause any complications, but even if there was a risk, at least I'd know.


UPDATE: After reading the advice on the BPAS website again (probably with a clearer head too!) it recommends taking 4 of the 6 pills straight away, then the remaining 2 a few hours afterwards. I still don't know if taking 6 all at once would cause problems, but I will update this blog post again once I have contacted BPAS.



Resources

British Pregnancy Advisory Service: https://www.bpas.org/

Depression Test PHQ-9: https://patient.info/doctor/patient-health-questionnaire-phq-9

Generalised Anxiety Disorder Assessment: https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7

Medical Abortion Up to 10 weeks: https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/abortion-pill-up-to-10-weeks/

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

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



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