90% of the review meeting I had with the CMHT psychiatrist turned out to be about the Tavistock funding issue. He began by saying that given the current economic climate, and the dire shortage of money available for out-of-area treatment, it was not a question of IF I stop seeing A, but when and how it is managed. Since he is also of the opinion that the *only* truly effective therapy is short-term, goal oriented work, he would not be supporting my case. Apparently this is also the opinion of the entire psychotherapy service in York. I brought up the fact that the consultant psychotherapist I have been seeing for 4 years has a very different opinion, and thinks it is important that our work continues. He said that if either she or the Tavistock were funding the therapy that would be fine, but since they’re not her view is inconsequential.
I asked him whether he had arrived at this from a clinical or a financial perspective, and he said that for him the two were inseparable. I pointed out that if the Tavistock treatment is withdrawn and no adequate replacement found quickly enough, there is a risk that I would be turning up A&E more frequently or requiring an inpatient admission if I am unable to manage, costing the NHS more money than the price of the therapy itself. Since this year, with the support continuing, I have already had to receive medical treatment for injuries and be assessed by the on-call psychiatrist at A&E on seven separate occasions, two of which involved ambulance transportation, that this would be the case is not wildly improbable. The doctor agreed that I had a valid financial argument, but explained that the problem is that the funding of the NHS is not quite as cohesive as it would need to be to recognise this. It’s a question of different pots of money for different services.
The economic problem is very real, and it’s not his fault. I understood what he was saying, and I also know that the treatment I receive impacts on that which is available for everybody else in the region. I have been very lucky to have had the therapy on-going for so long – it isn’t available to most people who could profit from it. What I did take issue with, however, was his idea that A plays a completely “supportive” role in my care, suggesting that since I am not symptom-free, the work has not helped me to make any real lasting changes. I vehemently disagree with this – and I asked him to leave alone his general views about therapy for a moment and just LISTEN to me. It really isn’t a matter of being attached to a particular therapist, and not wanting to let her go simply because it will be painful. A too is of this opinion. In the past four years, things have changed quite radically. I am no longer in and out of hospital every few months (my last admission was over a year ago), I have maintained my weight for almost a year and I am stable enough now to be able to complete a degree course – something which I have wanted to do ever since life interrupted me at 17.
He did listen, finally. And something positive came of it. Although it is still extremely unlikely the funding will be granted, he thinks it might help my case if I talk to the psychotherapy service here in York and get them to recognise the value of my treatment at the Tavistock and agree that the short-term therapy they could offer me would not be appropriate. He said he would refer me to a colleague at the service so the conversation could take place. I also told him about the psychopath dream, which seem to amuse him. He said he didn’t even need to turn up to my appointments – a cardboard cut-out would stand in for him just as well! On a more serious note, he wanted me to know that all of this had nothing to do with the way he or others in the service perceive me. It is not a case of personal dislike getting in the way of providing me with help. As I told him, I do know this, rationally. Emotionally it is another matter.
Therapy yesterday was tough. I spent most of the session crying. A has begun to use the past tense when she talks of our work together. We discussed what would happen when the therapy ends – she suggested the option of paying privately for psychotherapy, though since I have no income I would have to talk to my mother about this (who, I might add, is not likely to help). I asked if she meant paying to see her, and she said “yes” – “or someone else”. Ideally of course I would love to keep seeing her, even if I have to pay for the privilege. But realistically it’s not likely to be affordable, since I would also have to pay travel costs. Introducing the money aspect more overtly into our relationship is also likely to change it drastically. I’m sure she is aware of this, and although she conceded it as a possibility that I could pay to see her I am not sure she really thinks it would be the best option for me.
We are coming up to a month of anniversaries – my father’s birthday and the day of his death. Not the best time to be dealing with this. But is it ever?