My name is Vicky Malkin. I am 58 and currently working as a part-time administration assistant in Greater Manchester.
I first had therapy when I was 17, and have had to go back into therapy several times. Mental health treatments have changed over the last 40 years, so I have experienced various types – individual psychotherapy, group psychotherapy, person-centred counselling, and cognitive behavioural therapy. Some have worked better than others.
My first sessions of therapy were during my A-level studies. I started becoming increasingly tearful, withdrawn, and unable to concentrate, so went to see my GP for advice. He referred me to a psychiatric clinic and I was diagnosed with depression, brought on by the stress of studying whilst also trying to deal with some difficult family relationships. I had seven one-to-one sessions with a psychiatrist, once a fortnight. I found it hard to talk about my problems and very often ended up in tears. It felt like visiting a dentist and having a tooth extracted: painful at the time, but necessary for long-term health.
My initial understanding was that one round of therapy would fix things for good; however time has shown that not to be the case, and I have had to accept that my problem is a chronic one. I have learned that life events seem to have an inordinate impact on my mental health. Triggers for relapse of my depression have included bereavement, redundancy, bullying, and various bouts of physical illness. When feeling physically well, I have the strength to keep myself mentally well; when I feel ill, I am less likely to do the things that keep me from descending back into depression.
Group therapy I found least effective. The psychotherapist running our group let the group drive itself, within certain basic rules, without giving us any feedback or analysis of our behaviour. I felt that we were being asked to analyse each other, but none of us had the training or insight to be able to do so successfully. In group therapy, your need to talk can be overruled by the greater needs or demands of others, and very often I would leave the session feeling frustrated that I had not been able to have my say. I stayed in group therapy for two and a half years, but I don’t think it helped a great deal in the long-term.
Individual therapy has been most useful to me. I do not have a support network of friends and family that I can access, and so I need a professional to listen to me and to let me talk unhindered about my world view. Outside the therapy room, I tend to put on a front; that everything is fine and I know what I am doing. Within therapy, it is a joy to be allowed to be honest, to be myself and to know that no matter what I say, I will not be ridiculed but will be treated with kindness and respect. The individual therapy I have had has always been in short courses: between six and 12 sessions, held either fortnightly or monthly.
My last major episode of depression five years ago was triggered by a bout of flu and the pressure of work at the time. My emotions became uncontrollable – I would get angry at nothing, out of frustration that no-one seemed to understand how I was feeling; I would loudly berate my colleagues for their minor errors. I could become utterly despondent at small setbacks and felt unable to attempt even the easiest of tasks. Finally, I burst into tears during a meeting with my boss and she gently suggested I should seek some help.
My GP referred me to the local mental health service where I waited over 12 months for treatment. I finally had 12 sessions of CBT, seeing a therapist for an hour every fortnight. At the start of each session, I would have to fill in a short wellbeing questionnaire. (The scores from this would be used later to show me the improvements that were being made in my mood and anxiety levels during my progress through therapy.) I would then be asked about how things had been since the last session, and this would be my opportunity to talk about whatever I had found difficult, challenging or upsetting, and my therapist and I would work through the issues together. Therapy is much more a joint effort now than it was 40 years ago.
Over the years, with the help of therapy, I have identified where my chronic lack of self-esteem comes from. Knowing the source does not make it any easier to change. However, each round of therapy has brought new weapons into my armoury in the fight against depression – sound files to induce deep relaxation; the balloon theory of anger management; tips on recognising when negative beliefs about yourself are being triggered; thought records, and how to analyse them; plus a variety of worksheets, books and how-to texts.
I have also learned how to get the best out of therapy. You have to show up regularly, engage fully with your therapist and do the work they ask you to do – experiments in behaviour modification, worksheets, or other exercises. It can be hard work, but the more effort you put in, the better the outcome is likely to be.
The challenge of therapy is being honest with yourself and your therapist. It is tempting to hide parts of yourself away and not admit the emotions you are feeling, but you need to be open and to face the things you fear the most. The relationship between you both is the major factor in getting a positive outcome, so you need to have confidence in your therapist. I have experienced some very good and caring therapists, but also some who appeared to just be pretending to care. Ideally, you should discuss any misgivings directly with your therapist; but trust your instincts and find another therapist if you do not seem to be showing any improvement.
The biggest lesson I have learned is to seek out help early. The longer you leave asking for help, the harder it will be to get well again. NHS waiting lists are long for higher levels of support, so the earlier you ask, the more likely you are to be seen quickly. Finding a private therapist will bypass NHS waiting lists, but costs do have to be borne in mind.