Placement on an Acute Mental Health Ward

June 30, 2008 at 9:30 am | In Everyday stuff | Leave a Comment
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Well I’ve done four long days so far. It’s very interesting. I’ve definately learned stuff in that time. I’ve learned things I don’t know but didn’t know I didn’t know. That’s good. It’s the first stage of developing competence in a skill, moving from unconscious incompetence to conscious incompetence. I like the way this article applies the competence cycle to nurse training.

A particular situation, well patient, has been a real challenge. He’s acutely psychotic. It’s obvious from how he is presenting that he is extremely delusional, his thoughts are very disordered, he’s feeling paranoid and he’s hearing and responding to voices. He’s also pacing and occasionally running from one end of the ward to the other. He appears to have boundless energy. Every now and again, he’s tearful and has asked one of the male nurses to hug him a couple of times. The man is clearly extremely unwell and seems to be getting worse rather than better.

I’m so aware of having no clue as to how to ‘be’ around him, what to say and what not to say, when to persevere with communication and when to move away and feedback to a trained nurse the way things are going. They seem to be at least partly able to assess how his psychosis will develop over the next few days as the medication is adjusted. They also seem partly able to contain him and encourage him to sit for a while. They can temporarily de-escalate his mood and behaviour. I have, at points, asked him to sit down when he’s been pacing and offered reassurance that he’s safe and it has calmed him for a while. But I don’t feel so confident to approach him when he’s running up and down the ward, roaring. I want to be able to do what they can do. But he scares me.

I had a chat with someone about this guy and how I feel. I was really honest. They basically encouraged me to ask somebody to be nearby while I experiment with different ways of de-escalating situations when I feel ready to have a go. I feel safe with the team here. It’s a good place for students. They are free with the feedback – good and bad – so you really know where you are. So I will take every opportunity to begin to learn ways of dealing with acutely psychotic patients and trying the various methods out.

I want to be a good nurse.

I love this placement.

 

Therapeutic boundaries

June 20, 2008 at 12:09 am | In Everyday stuff | Leave a Comment
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Some nice lady replied to this post about my therapist. She said “he has a very kind face. i like him. i think he is a very clever chap”. Only she didn’t say it in italics. She said it in upright letters.

It made me think about him some more. I think he does have a kind face. It amazed me how he always managed to demonstrate unconditional positive regard and empathy week after week, year after year. He really did ‘get’ me pretty much from the start. Which was good. Because I had no f***ing clue. I should say ‘almost always’ rather than ‘always’ demonstrated UPR and empathy. I think maybe twice in seven years he seemed somehow different, distracted, like he wasn’t really with me in the room. One of those two times, he was trying to suppress yawns throughout the session (my appointments were 9.30am). I don’t think he did at all badly, two non-empathic (or less empathic) sessions in all that length of time. And those two sessions were as important as the others in the bigger picture of our journey. They made him human. And gave me an opportunity to wonder about what stresses and strains might be part of his every day life inside and outside of his work. And they showed me that I cared about him too. Both times, I spent the next few days wondering (not worrying) if he was okay and what it had all been about. I felt more connected to him in a way even though I never mentioned anything.

But his cleverness struck me more than his kindness. He was kind. But lots of people are as kind. And I don’t know how kind he was outside of my one hour sessions. He might’ve been a right old miserable git for all I knew. But he really was clever. I don’t think many people are as clever. The way he demonstrated trust in me and hope for me was clever. I felt as though he respected me and my resources and coping methods. I didn’t respect any of those things in me at first. So what he seemed to believe about me had a powerful impact.

And his boundary setting was clever. And surprising at times. Early on, when I was really quite distressed for most of our time together, he explained his feelings at my distress. I can’t remember his words but he was basically saying that when you see someone so upset you want to hug them. Especially a child. At that time I was probably functioning at the emotional level of a traumatised 8 or 9 year old for the most part. I really couldn’t understand what he was feeling because I didn’t know then how it felt to love someone, let alone somebody extremely distressed. And I had no concept of the love adults feel towards children. I now know those feelings well and understand his need to work it out with me at the time. We had some kind of (terrifying) conversation which basically resulted in an agreement that he would touch my index finger with his index finger when he wanted to comfort me. It makes me smile to remember. Literally. And feel all warm inside. It was a very uncomfortable but healing learning curve about people and the world and me. After a while, probably for the last three years, we always hugged briefly at the end of the session. I’m not sure if that’s the norm for other people but I didn’t expect it within a therapeutic relationship.

Another thing that I didn’t expect was the whole ‘ending the session’ thing. I pretty much always ended it, as far as I can remember, not him. Sometimes a couple of minutes before the allotted time, sometimes a few minutes after. If I went on a bit longer, it was only to finish off what was going on and put it all back in the right boxes. And it was with much apologising. But I always felt as though he trusted my motives and knew I would never go far over the time.

And he always sent me postcards from holiday. I’ve still got them.

The last boundary-related surprise I shall mention relates to the end of my therapy. I was ready and happy for it to end. I’d only been seeing him monthly for ages anyway. But I knew I would miss the sessions. And I knew I would miss him even more so. It’s not the norm to let someone in so deeply and then never ever see them or hear from them again. We had a lot of conversations about it. Occasionally he had read stories to younger parts. And somehow we agreed between us that he would read a story and I would tape it. So somewhere, I really don’t know where, I have a mini-cassette with him reading ‘the tiger who came to tea’.

The end :)

A good friend came to see me today

June 12, 2008 at 1:00 am | In Everyday stuff | Leave a Comment
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We had a good chat about all sorts. I really enjoyed spending time with her. I like her a lot. She’s the only person off my (mental health nursing) course that I actually want to spend time with in the holidays. She’s easy to be with. She’s clever. She’s interesting. She’s funny. And she’s human. The hours flew by. About 4 of them. And I could’ve easily chatted for another 4.

I was slightly worried about her if I’m very honest. She’s doing too much. And she seems to be dragging herself through each day without much to look forward to. I don’t think that’s great. And I don’t think you can do it forever. I hope she takes good care of herself. Soon. xxxxx

Tomorrow I will find out my shifts for my next placement which starts in about 10 days. I am expecting a struggle. I am expecting to be a bit dissociative at times. I am expecting (at times) to feel like a six year old abandoned far from home. That’s how I generally feel when the agoraphobia kicks in. That might be because that’s when and how it all started. But I think I will survive it. And I think I will function okay on placement. I think I will be able to contain the trauma to times and places where it is acceptable not to be okay. That’s good enough for me.

If and when I qualify, I don’t intent to get a job outside of the city in which I live.

Agoraphobic’s Dream Holiday

June 12, 2008 at 12:02 am | In Everyday stuff | Leave a Comment
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I never used to enjoy going on holiday much. It was never really worth the effort. Usually it was one long trauma. Me and my friend (who I live with) have some ‘fond’ memories (NOT) of specific attempts at relaxing away from home for a few days many moons ago. One such vacation involved driving round for hours on end in search of a chemist and buying up enough Kalms to bring a herd of elephants to a standstill. Didn’t bring me to a standstill on that occasion. Unfortunately. For both of us.

Nowadays I enjoy going on holiday. Thanks in part to a little caravan off ebay. I reupholstered the cushions in fabric I like and made curtains to match. I put a few bits and pieces from home inside. Before going away the first time, we spent a couple of nights in the caravan at the bottom of our garden. It was bloody freezing. Did the trick though. We’ve been away in it loads now. It’s home from home. I do get anxious at times. But if it gets a bit more than I’m comfortable with, I can sit in the caravan with the curtains shut and I’m basically back in a place I’ve been loads of times and know really really well. I don’t even take a bottle of kalms these days.

Thankfully my ever so slightly wierd friend doesn’t mind. She doesn’t have any desire to venture outside of the UK anyway.

Tomorrow we go away for three nights. I’ve sorted out some bits and pieces to do. Some reading for my course. I might or might not look at it. I don’t have to. And some crafty stuff to get on with. It’s a lovely little campsite. And there’s a couple of little villages nearby. With pretty shops.

(Just for the record, I don’t sit there for three days with the curtains shut pretending I’m at the bottom of my own garden).

Therapist

June 11, 2008 at 11:26 pm | In Everyday stuff | 2 Comments
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This was the man I saw every week for a while, then every fortnight for a while longer, then every month for a bit. Then we said goodbye. That was 15 months ago. All in all, I saw him for about seven years. I think about him every now and again. Sometimes I miss him. I loved him. And I trusted him. I asked him if he loved me too. That kind of proves how much I trusted him. I asked him all sorts. And I told him everything. One night I stalked him on the internet and stumbled across his address. I told him about that. He didn’t seem too phased. I never went to his house and I never would. Even though I’d love to tell him what I’m up to now.

The last question I ever asked was ‘can I take your photograph?’.

Cortisol

June 5, 2008 at 8:08 am | In Everyday stuff | 1 Comment
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I just thought I would come and say hi. I don’t feel very dissociative anymore. And, to be honest, it’s pretty excruciating to read this blog. When I’m not dissociative, which is most of the time, I have a fairly integrated view of myself. I see myself as a whole unit. I feel whole. I’m not saying I never feel slightly younger, older or a bit spacey. But I think it’s at about the same level as everyone around me. It’s how I imagine everyone else feels. Personality is a bit fluid anyway I think. I don’t find this blog triggering. It doesn’t upset me. It makes me feel slightly ashamed. Not because I feel bad about what’s written. But because I have no awareness of feeling that way. Which makes me a liar. I think I must’ve been playing games. For attention or something. Exaggerating it all for effect. That’s basically why I stopped participating on dissociative communities – online and real life. Because the freedom to be very honest is there, everybody is very honest. I was very honest. I would go back the next day, see words next to my user name, feel like a liar, then hate myself for a bit. All very bizarre.

Even though I’m much less dissociative, I’m still pretty vulnerable at times. Sometimes it really impinges on life. Mostly, I don’t cope well with severe stress. I overreact in the first instance. I need to eliminate all stress factors. There’s no concept of reducing stress and navigating my way through it. I feel totally overwhelmed. And I can’t think. All the worst case scenarios go round and round in my head in a loop. Nowadays I do know what I’m doing. I do know my thoughts are the problem. I know it’s the way I’m looking at things that’s causing the panic, not the situation. Most situations in life are do-able, one way or another. There’s usually a realistic satisfactory outcome to be found.

I’m really looking forward to the day that I can bypass the agonising traumatic process and go from recognising the problem to finding the realistic satisfactory outcome. I’m not sure I’ll ever be able to do it without a level of anxiety. All to do with cortisol. Apparently, the research says that people’s wiring is affected by repetative trauma. You really can’t help some of the response. Loads more cortisol is released under stress. Some of it’s just biology. I find that strangely reassuring.

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