Over the past thirty plus years I have worked in a variety of therapeutic roles with many people with varying degrees of mental ill health, from stress and anxiety, mild, low-mood to the deepest black hole of severe depression and suicidal thoughts; within a residential community, Social Services and the National Health Service and continue in my private counselling practise. I use an integrative model, depending on the client though favour a psychodynamic approach, that is, making the unconscious, conscious, as so much of who we are today stems from our early, often repressed, suppressed, formative years. Am currently a publicly elected governor with Essex Partnership University NHS Trust.
The residential community I first worked with was, at the time, one of only two of its kind in the country, the other being The Richmond Fellowship who delivered much of our training and supervision. The aim was to work in innovative ways with residents, ‘community members’.
I was new to residential and no doubt naive having been thrown in the deep end but I could see that a number of staff appeared to have more ‘issues’ than the residents. My ‘supervisor’ was a trained nurse though had not worked in that role for several years and had no mental health training. Never-the-less I learnt a lot in my three years with them and have some fond memories of both staff and community members.
Matthew: All names have been changed.
After several months I was relieved to be allocated a new supervisor who was experienced, respectful and supportive of my ways of working and my perspective. She had been in a team who were trying to work with alternate ways of helping clients who hear ‘voices’. Examples; to try not to ‘own’ the voices as in, ‘my’ voices and whether responding to ‘voices’, rather than trying to block them out, could be therapeutic. Matthew wanted to give it a try.
He was in his thirties, visited family most weekends and had said that walking across the field and alongside a lake to the bus station was when his ‘attacks’ were at their worse. The following Friday evening as usual as he walked he was drawn to the water and the voices began telling him to jump in. Matthew had explained that the terror of not obeying the voices had been worse than the fear of drowning but this time, instead of trying to block them with his hands over his ears, he replied,
‘No! I’m going home’. Then turning to me he said, ‘And I realised it was a load of bollocks. You know? What they were saying, if my mate had told me to do that I’d have told him to fuck off!'
He went on to say that it was as if a door had opened and he could choose to step through or stay locked inside. Of course it was not all plain-sailing but Matthew left the community a few months later a much freer and peaceful man.
Abused and violated on many levels and who, when I resigned, presented me with a pair of Indian cotton trousers; purples, blues and turquoise which she had bought from a charity shop. I don’t wear second-hand clothes, repercussions of being a kid and wearing everyone else’s but I did wear those trousers and still do. That was over 25 years ago.
‘You cannot keep birds from flying over your head
but you can keep them from building a nest in your hair’.
One of Alim’s favourite quotations, though he spoke very little, well, in the presence of staff anyway.
In his early twenties, Alim still looked boyish - fragile - slight. His controlled food intake and exercise regime meant that he walked miles daily so was outside the community setting for many hours at a time. I'd rather not read case-notes extensively unless of course I need to know of any risks, preferring the person to confide in me if and when they want to though I knew Alim had been abused repeatedly by a paedophile ring before he came to England. We would often spend our allocated sessions in silence which became easier for me with more practice and I could relax and ‘be’ not ‘do’, more recently known as ‘mindfulness’. Never-the-less I felt I was letting Alim down, maybe he needed someone more skilled, more experienced than myself? He offered no response when I told him I was leaving and did not attend my leaving ‘do’. Several weeks later I received an envelope with a post-mark I recognised. Inside, a silk painting had been stuck to a piece of folded card with the words, ‘Thank you, I will miss you.’ Inside they continued, ‘I was always too frightened to get close to anyone….but I really love you…’ Still brings a lump to my throat.
It was not all success, there was the time when a community member threw a coke bottle at me because I had stood in front of the TV and learning the invaluable lesson of never telling anyone to ‘calm down’ after being drenched with a mug of tea, fortunately only luke warm.
I have developed further ‘tools’ for clients who find it difficult to verbally express their feelings, either due to never being allowed a ‘voice’ or for those who struggle to find the ‘right’ words. Always their choice of course; we have worked with drawings, dreams, toys, buttons, clothing, stress bucket!
Working with clients is a two way thing. Not in the counselling sense of ‘projection’ or ‘transference’, more in that if we aim to be really present with our client, we learn things about ourselves also. Two people may appear to be sitting in silence but there is often cacophony in the room. It was partly experience gained in that therapeutic community that set me on the path of alternate ways of working. Although Carl Rogers is always associated with the client centred model, in my opinion, congruence and unconditional, positive regard is essential in all therapeutic relationships and may provide a conducive environment for the deepest revelations.
We worked together in my role as Family Group Conference Facilitator Mental Health. Leah had attempted suicide several times. An intelligent woman who had been teaching in Higher Education until she became unwell.
Leah had developed compulsive disorders and was also becoming violent towards her husband. My role was to meet with her and help her plan her ‘conference’. I would then contact the family members and friends she had invited and meet with them if they wanted to be involved.
Family Group Conferencing is an invaluable service. Provides opportunity - and permission - for all participants to put a face to a name, share feelings, suggestions and agree boundaries; providing a framework of security around the service user. The process also gives opportunity to air the myths around mental illness; for example, ‘suicide attempts or self harm are merely cries for help’.
It was once thought to be the case that if a sufferer speaks about suicide then they would not carry out the act but that is a false theory. Through my experience I am persuaded that the majority of those who suffer in this way do not want to die, they just cannot carry on living. Often these very intelligent, gifted sufferers have formed their own diagnosis, prognosis and course of treatment and appear to have made the decision to end their life with a 'sound mind’. Hard to understand, it almost appears to be a different aspect of mental illness - possibly requiring an independent or additional diagnosis but…I am not a clinician.
I was speaking with a company director about my work and he said that even though he is on the board of a mental health committee, he actually finds the topic frightening. I suspect that most people who work outside the field only consider severe conditions, such as psychosis and schizophrenia as mental illness, when in reality, addiction to alcohol, shopping, food, social media, are also examples of symptoms of mental health imbalance to a greater or lesser degree.
Regardless of background, status, age or gender, mental health is a common denominator and statistics show mental ill health as a growing problem, with anxiety and depression reported as the most prevalent condition. At a time when funding is being cut from many services this can be a challenge, however promoting mental health awareness does not need to be costly and I feel it is time to add ‘mental health awareness and well-being’ to the school curriculum and encourage larger companies to include mental health awareness in their induction process.
Hopefully adopting these practises will assist with normalising the topic, allowing discussion to be frank and feel less threatening and preventing feelings of isolation.
'Bed of Black Flowers: diary of an unwelcomed child' Poppy Ann Miller