Thursday, 12 July 2007

Little boxes, little boxes, little boxes all the same

"So," said the trainee psychotherapist, the one being critically observed by her supervisor, who didn't appear to be much older than she herself was, "Can you tell me, in your own words, what's brought you here today?"

I chewed my bottom lip, wondering who else's words I would be likely to use in a situation like this, and considered some possible responses.

"Because being on first-name terms with the area paramedic crews really isn't a good way to endear yourself to the local community. Especially when you've only just moved in."


"Well, frankly, staying in bed all day is playing merry hell with my basal metabolic rate, and I'm sure I'd feel much better about myself if I were a svelte size twelve."


"Quite honestly, taking taxis everywhere because walking seems too scary is costing me a bloody fortune, and I *am* on the dole, you know..."

In the end, it was the tissues that did it. Why is there always a box of tissues? There they were, in the very edge of my field of vision - on the one hand all white and stark and clinical, on the other, an unspoken invitation; open up, let it all out, it's OK to do that here - and I ran out of smart-alec answers on the spot.

"Truthfully," I said. "I'm here because this is doing my head in."


This being an initial assessment, there were lots of questions to be answered. I rambled, as I have a tendency to do in job interviews, possibly because this felt a little bit like one.

Then came the crunch. The Big Question.

"What would you like us to do for you?"

I hate that question. The last time it was asked of me, the neurologist looked me up and down over the top of his regulation consultant-issue pince-nez and told me that as I didn't fit neatly into his particular diagnostic box, didn't I think I would be better served by a member of the Royal College of Psychiatrists than a member of the Royal College of Physicians? Which was so dignified that nowadays, I try to avoid that question like I would a plague of locusts.

This time, then, I was leaving it up to them.

Counter an open question with another open question is what was going through my head.

"What would you suggest?" I asked.

"There are lots of options," she said. "Firstly, there's Computer CBT."

Gosh - surely the ultimate in self-help. I've heard of CBT. I've even had it before. This, apparently, is different. You turn up at your treatment centre. They log you in. They leave you to it. You do exercises on-screen. Someone comes in at the end to check what you've done, and this is how you get all better.

Now, I know a little bit about usability. I've worked in the interweb field for ten years. I also know a little bit about how people read things on a computer screen and why there's a reason that the inverted pyramid model of journalism is so important when writing for the web.

People scan. Quickly. This is not a good medium for "taking stuff in."

So, while smiling to myself at the memory of the short-lived Ananova newsreader, I politely declined the offer of a virtual therapist, and asked if I could maybe have a real one instead.

And for once, a mental health professional nodded, smiled, and agreed with me.


Before my appointment, I sat in the waiting room opposite the transsexual with the blond wig and too-short skirt - why is the skirt always too short? - and as the second-hand chugged around on the clock, I filled in a yellow questionnaire containing what seemed like hundreds of boxes.

"In the last week, how have you felt about X, Y and Z?"
"Have you thought about killing yourself?"
"Have you had enough energy to do the things you normally would?"
"Have you felt anxious to the point where you really couldn't stand it any more?"

Terrible, god no, not at all, constantly... repeat ad-nauseum.

Tick, tick, tick.

I ticked boxes.


So, I'm now a questionnaire on someone's file, and I'm sure I now fall somewhere within the diagnostic criteria for something. Where, and for what, remains to be seen. Having fought labelling for the better part of ten years, this is annoying in itself, but in order to get help, I know I have to play the game, to accept the label, even if I choose not to apply it to myself.

Take what you need and leave the rest, isn't that how it's supposed to work?

We shall see.


An Unreliable Witness said...

Brilliantly observant writing, Miss Vertigo, which made me smile with recognition on more than a few occasions.

I am still of the considered opinion, however, that two of the most frightening words in the entire English language are "trainee psychotherapist".

Miss Vertigo said...

You're telling me - 'bloody terrifying' is the phrase I think I'd pick. It was either that, or wait until October for an appointment, though.

Thanks, UW, as ever.

Izzy said...

I'm not sure what it says about me that I just read "basal metabolic" as "balsamic". On the plus side, any therapy might then involve strawberries I suppose...

Migraineur said...

Just found my way over here from your comment on The Daily Headache. I agree with UW - your writing is really crisp. I'm glad I found you.

Boy, does this post bring back memories of my first shrink visit. Or really, my first visit with a number of different shrinks until I settled on the one I liked.

I think I can come up with a more frightening phrase than "trainee psychotherapist." It is "psychiatric resident." Imagine taking psychotropic medications prescribed by Doogie Houser, MD.