About a year ago, I started CBT treatment with the NHS eating disorder service. I was referred to the service when my life was in total freefall. I was vomiting frequently, and alternating between starving myself for days or binging until my stomach looked pregnant and the vomiting was involuntary. The process of being assessed and getting into treatment took forever – the first therapist I saw was male and triggered the hell out of me, then there was a period of flux whilst I met and got comfortable with the new therapist.
A and I have been working together since January. It was messy, difficult and whilst it was effective (in that I stopped vomiting and started eating regularly), I wasn’t making any genuine progress with my thoughts or emotions. The CBT process seems to try to teach you to stop the negative behaviours, and THEN deal with why you do them (it should probably be called behavioural cognitive therapy, not the other way around!). This wasn’t working for me – we were watching as I repeated the same patterns over and over and over because the emotions overwhelmed me and I used the only strategies I had to make things feel better. A quoted me in her discharge letter as saying the disordered eating patterns are the “healthiest unhealthy way I have of coping”. I remember saying it in a session where, once again, I was being told off for starving myself on one day when I was so unhappy I desperately wanted to cut myself but instead I ‘only’ starved myself. She would not teach me positive strategies until ‘Phase 3’, which meant that I was constantly using my negative strategies over and over.
In July, A ended CBT. At the time, I went absolutely beserk – I was trying my best, doing everything in my power to get better, and working my hardest to jump through their stupid hoops. But A stuck to her guns, and over time I came to realise that CBT really was not working for me. My reasons for my ED are so complex, so deep seated and with so many roots in my trauma background, that 20 weeks of telling me to write down everything I ate probably isn’t going to cut it. They offered me Day Treatment, but I turned it down – I would have to give up my job, which I absolutely adore, and it also wouldn’t help me with the true issue, which is looking after myself when I’m all alone. I’m very skilled at making it look fine when I’m with people – but the problems come when I’m on my own.
So, we ended, and in the months since, we have been working towards an ending. I have huge attachment issues, and endings are always a nightmare. To be totally honest, I didn’t trust that A would properly understand and manage an ending properly – she has been so naive throughout a lot of this process that I was really worried she would upset Little at the end and leave me with some major problems.
But she didn’t. By the time the ending came around, I felt pretty good about leaving the service. We spent a number of hours together identifying the true root of the ED issue, and it is my inability to be self-compassionate. There used to be an NHS group therapy thing that would have been helpful, but it has recently been stopped. Thankfully, a friend did the course a few years ago, and so has the handbook. I am going to ask T if she doesn’t mind working through it with me – it will be good to do it on a 1-2-1 basis anyway. But I guess by the time that we ended, I was happy that the ED is the symptom, not the cause. And that feels okay.
Our ending session was nice. Bit of a bland word, but it was a bit bland in the sense that I didn’t cry, panic, or otherwise feel the usual awful emotions I get at an ending. We talked a lot about what has changed in the year we have been working together. My eating is still poor – the vomiting is almost non-existent now, and although my eating still swings between starvation and binging, I am balanced enough that my weight is a good BMI and it is stable enough – I am not putting weight on in the way I had when things were really bad. So although it isn’t perfect, it is better. Much better. But everything around it is what has truly changed for the better.
I am into my second year of a job that I love, one that I am successful at. My mental health is balanced enough to keep me in work – things are tough outside of working hours, but it are calm enough to ensure I survive through my working day. I have been single for nearly a year now, and in that time I have developed my own indepedence. I live in a house that I absolutely love, and although it is a houseshare and there are other people around, I am very comfortable in my own space (so much so that I get a bit grouchy when people are in it now!). I have a close network of friends that I could only dream of a number of years ago – I’ve spent my life watching sitcoms and wishing for friendships like that, and now I’m suddenly there. Most importantly, they’re friends I am honest with – they know what is going on for me, and I don’t have to be fake in front of them. I feel genuinely accepted, and the phrase “friends are the family you choose” makes so much more sense to me now. I still see my ex and my beautiful dogs regularly, and we have a really good relationship, which after 7.5years together was really important to me to maintain. I didn’t want to fall out with him, never see him again, spend our lives dancing around each other and ignoring each other in the street. But most importantly, I’ve made so much progress in therapy. The lows feel lower, but the highs are absolutely awesome now. I am living a life that (when everything is okay) I love. And although there are some real bad points – the self harm, the dissociation, the panic, the anxiety, the ED, the nightmares and the trauma left behind – they are getting better. I am healing and I can see the pathway which will take me to the place where I am genuinely free from my history.
I always want everything done yesterday, and I often get very stressed and angry when I see myself getting older and nothing feels like it is changing. So it was nice to have a session where we talked about how much has changed. I was able to, very genuinely, thank A – though she perhaps hasn’t been able to fix me in the way I had hoped, and there have been multiple problems along the way, if all she did was support me whilst I made changes and grew in the rest of my life, then she had a hugely important role. Perhaps just being able to hold me stable enough with my vomiting and food to allow me to make those changes in the rest of my life was her role. She was quite honest with me, in saying that she started her job to help people grow and make changes – and she feels like she’s managed that, at least a little bit. Yes, she hasn’t achieved the tick-box successed the ED team would have hoped for, but she has helped me make the changes in my life to have more of a change of getting there one day. We talked about how I feel like I have a much more solid foundation now, that things are built on much more solid ground. This makes any slips less dramatic and any trips only shake the ground, not crack it and destroy it. I may not have cured my ED, in fact, far from it – but I have put the groundwork in place to get there. Eventually.
A offered to write me a letter as a way of giving me closure to our therapy. T2 did this, a year and a half ago now, and it really worked as a way of closure. T2’s letter was very personal, and I never shared it on here, but I want to share part of A’s because it sums up the progress I’ve made whilst working with A this year.
I would like to conclude this letter by saying that it has been good to meet and work with you, throughout the time I ahve known you I have found you to be a very resourceful and self-aware person who has overcome a lot of difficulties in order to begin building a life and a career. I have seen you grow as a person and use your skills to get through some very challenging situations in your job and become more independent since the end of your long term relationship. Something that is particularly admirable is your passion and dedication to your job, something that you have fought to maintain despite all of your difficulties.
Although you have clearly struggled with the idea of ending treatment with me, I firmly believe and have observed that you have a significant level of insight and many positive attributes that will guide you towards your eventual recovery. I wish you well with your journey from here. I feel it is important to recognise the journey we have shared and the improtant work we have done and hope that you have taken something of value from our time together, as I have.
So, there we are. A milestone in my journey, but not the end. At the end of my bed hangs a quote, bought for me by my best friend. It says, “take pride in how far you have come, and have faith in how far you can go.” I am feeling proud of myself for where I am now. I worked bloody hard to get here. I am so proud of myself for at least being self-compassionate enough to allow myself to work this hard in therapy towards my healing. The rest will come, in time.