Past Talking

[Wonky]

Was happens when you have had lots of counselling and a number of courses of psychotherapy, none of it seems to have made any difference, and you just don't want to talk anymore?

This is my situation.

My current diagnoses are depression and Generalised Anxiety Disorder.

Oh yeah, and I have never got much out of psychiatric meds.

Are some people very difficult to treat, and perhaps even border on the untreatable? Is such a situation recognised? And what happens then?

 

[unlucky]

This is the position I'm finding myself in now as well. I too have clinical depression and GAD and am mildly agoraphobic (I can leave the house with my husband but only with him) and mild OCD. I had pyschology for a year until the pyschologist gave up and said there was nothing he could do. Over the years I seem to have been on every anti d known to man and I now have a pyschiatrist but nothing seems to work. I'm now at the stage where I'm thinking of coming off meds altogether because the side effects are worse than any good they could do. Its very frustrating and when I go to the pysch I feel as if they think I'm making it all up because nothing seems to work.

 

[KP1]

I feel the same. Sometimes in therapy I'm told I am resistent and I can recognise that but at other times I am trying my best not to be resistant but can't help it. I think it is a defence mechanism.Another problem I think for me is all the therapy and meds in the world won't change some of the life/family problems that I have got and can't change.

 

[unlucky]

Thats the thing KP, I'm the same. I'm just trying to attain some acceptance of my lot in life because if I don't do that and can't let go of the past then I've got no chance in the future.

 

[shaun3210]

I felt how you described for many years Wonky and pretty certain I was untreatable, but I have started to realize over the last year or so that it is part of my MH condition that was causing it, in the past it has stopped me asking or receiving help when it has been offered, I do seem to find it easier since I realized it.

I’m not saying that’s what’s going on with you, but maybe worth considering or some other reason why you don’t seem to be able to get much out of counselling rather than go to straight to the fact your untreatable

 

[Wonky]

Thanks to KP1, Unlucky and Shaun3210 for replying.

I absolutely agree with KP1 and Unlucky about life problems. I rather think that MH services are unable to really address this factor because the psychological paradigm of psychotherapy takes a view that the problem is YOUR bad reaction to things rather than the bad things to which you are reacting in an understandable way, and psychiatry takes a biological view. Also, I think it is difficult for MH professionals to fully acknowledge the major impact of life problems because mostly there is nothing they can do to help you in a really effective and practical way, and, rather than parade their powerlessness, they understandably stick to things that are within their power, e.g. psychotherapy and meds. Also, as with everything, one has to also remember the lack of resources in MH services.

With regard to Shaun's point, I have to say that virtually all the counselling I've had has been outside the NHS, and therefore was something I sought out for myself rather than passively accepting from a doctor, and I think that demonstrates that during those years I was open-minded and fairly positive about that sort of help.

Some time ago I read an article about research at the Institute of Psychiatry into the possible genetic factors in some MH problems. The article had a bit about depression and said that 30% of the population are resistant to all types of anti-depressants. If 30% of the population are resistant to anti-depressants why can't a percentage of the population be NATURALLY resistant to psychotherapy? I am not having a go at you Shaun, but the insinuation that when psychotherapy fails it is the fault of the patient, gets right up my nose. Where is the evidence that psychotherapy has 100% effectiveness unless the patient puts the block up?

Where a person has chronic MH problems isn't it reasonable that at some point they need to take their own view on things, which may include the view that all the types of treatment they've had so far just do not work for them? But the problem is where do they go from here? I am not aware of anything in NHS mental health services they would assist them. I am going to use a word now that I generally despise - how about some form of "empowerment"?

 

[unlucky]

Wonky, thats really interesting what you're saying about 30% of the population being resistant to anti depressants - I've always felt more of a failure because none of them seem to work. I have got better before when I've been on anti d's but I've always thought that that was more to do with my circumstances getting better than the actual anti d's. Not sure whether to mention this to my pysch next week, they might take umbrage at the fact that they're beliefs are being questioned since most of them, in my experience seem to think they know it all!!

 

[Wonky]

Unlucky, please check what I've said before you use it to your psychiatrist - perhaps do a search on the internet. I am pretty good at remembering things quite accurately but I would not claim to be totally reliable.

There are many groups of anti-d, and each group seems to work on different chemicals in the brain, and each particular drug must be somewhat different from the others in its group. So there is quite a bit of scope with them.

 

[unlucky]

I just feel like I've been on every anti d there is and how many times do I have to change and get the adverse effects like feeling like a zombie and having no motivation (which could be my condition and not the anti d's) but never see any of the positive effects. MAybe it is just me and I'm just not open to getting better. All these things go through my head and its like a constant roundabout which quite honestly is making me very dizzy and I want to get off!!!

 

[shaun3210]

I haven’t taken it as your having a go at all wonky I wasn’t in anyway having a go at you making out you weren’t trying in therapy or anything like that, in fact I think I understand where your coming from because I have been in a similar place a few times over the years and been left asking the same question as you asked near the end of your post “where do I go from here?” when various forms of therapy haven’t been right for me or I have slipped back soon after they have finished.

I also agree on your point about “Where a person has chronic MH problems isn't it reasonable that at some point they need to take their own view on things” yes everybody is a individual and have to find their own way and "empowerment" (I don’t think that’s a word I have ever used before) but I do think you need some form of "empowerment" to get over a long term MH problem, where that comes from yourself or others I’m not sure?

But I have found keeping a blog on here talking about my issues both long term and day to day very useful, I had never considered keeping track of my MH issues in a written form before, I found it useful in getting things a bit straighter in my head and also being able to reflect back on them at a later date.

I wasn’t trying to say in any way it s your fault that psychotherapy didn’t work on you in the past, more point out that it didn’t mean it wouldn’t work in the future, I had it 20 years ago and a few times since the last time when
I was in a therapeutic community which I left early about 2 years ago and none of them worked. But what is keeping me going on pushing me on to find different ways of looking at things and different approaches is the question “where do I go from here?”

 

[Wonky]

Shaun3210 - despite everything I have to agree with you about the future, yes, even I am able to conceive that it is possible than one day there may be an opening for a particular sort of therapy for me, but not now, not now.

Unlucky, you've written, "MAybe it is just me and I'm just not open to getting better." I wouldn't, myself, take that point of view unless the MH professional treating me had 1) found out everything about me including life history and thought world, 2) that they had incorporated into their approach with me a full understanding of me as an individual so that their suggestions were likely to chime with me as an individual, 3) had fully acknowledged and taken into account the impact of life problems, 4) had exhausted all possible treatments.

I need to correct something in my reference to research at the Institute of Psychiatry. It is 20% of the population who are resistant to all anti-depressants not 30%.

“Making sure the right anti-depressants are prescribed 1

If you go to your doctor with depression, they will almost guess which anti-depressant to prescribe. But some people don’t respond to certain types of drugs and may not get better until their GP switches them to another sort.

A new international research project aims to banish guesswork and the ‘try it and see’ approach by developing a test to help doctors decide which anti-depressant will best suit patients’ genetic make-up.

The IoP is leading a team of scientists and clinicians from 10 countries who will study 1000 depressed people over three years and aim to link their genetic profile with their response to different types of medication.

These people will be treated with one of the two types of drugs currently on the market. One affects serotonin in the brain, the other affects noradrenaline, another chemical that send messages between brain cells.

By monitoring patients’ responses and analysing their genetic make-up, the researchers hope to find a way to help doctors know which anti-depressant will suit each patient best, depending on the design of their genes.

The GENDEP Project, which was awarded 7.5 million euros by the European Commission back in March 2004, has ‘the potential to revolutionise the treatment of depression’, says Professor McGuffin 2

There is, however, about 20 per cent of the population, who don’t respond to any drugs at all. ‘At the moment, we don’t know why that is,’ he says."

1 Research at the Institute of Psychiatry 2005-2006
http://admin.iop.kcl.ac.uk/randd/downloads/IoP_Research_Report_2005-6.pdf

2 Peter McGuffin, Professor of Psychiatric Genetics at the Institute of Psychiatry

 

[dib4uk]

There was a report published by the Psychology Review on the effects of anti depressants(2008-2009) and they prepossed a new form of therapy, but i cant remember what it is.

I vagerly read about it for a psychology report i was doing for my college course, but it was founded to be more effective in people who were drug resillant, and of course counselling really only works if you yourself realise that you have issues.

And Wonky, it also depends on the personality of the individual.

Sometimes things get stranger before they get okish.

 

[Wonky]

dib4uk, I am just going to say "argggghhhhh!". It isn't your fault but I get easily infuriated over the issue of psychotherapy. To be honest I believe that for the most part psychotherapy only exists in mental health services because a lack in medical science, and as a result of historical reasons, e.g. 1) Freud and talking, 2) by the end of the nineteenth century the advent of a more "enlightened" approach to mental illness, and 3) possibly the First World War, all those shell-shocked OFFICERS prompted a nicer approach.

I think there is enough out there for people to take a neutral view on psychotherapy. I know I am swimming against the tide because talking therapies have the touch of El Dorado about them and too many people have problems even getting to try them.

Just one thought - do you think a psychology journal is more or less likely to write positively about psychotherapy? There are a lot of vested interests (and mortgages to be paid) in the psychology versus biology debate.

Sorry I can't stop myself - is counselling guaranteed to work if one genuinely and truly realises one has issues? I doubt it.

 

[dib4uk]

dib4uk, I am just going to say "argggghhhhh!". It isn't your fault but I get easily infuriated over the issue of psychotherapy. To be honest I believe that for the most part psychotherapy only exists in mental health services because a lack in medical science, and as a result of historical reasons, e.g. 1) Freud and talking, 2) by the end of the nineteenth century the advent of a more "enlightened" approach to mental illness, and 3) possibly the First World War, all those shell-shocked OFFICERS prompted a nicer approach.

I think there is enough out there for people to take a neutral view on psychotherapy. I know I am swimming against the tide because talking therapies have the touch of El Dorado about them and too many people have problems even getting to try them.

Just one thought - do you think a psychology journal is more or less likely to write positively about psychotherapy? There are a lot of vested interests (and mortgages to be paid) in the psychology versus biology debate.

Sorry I can't stop myself - is counselling guaranteed to work if one genuinely and truly realises one has issues? I doubt it.

Ahhh dude, lol sorry didnt mean to , No nothing in life is guaranteed to work, because I can only go on by what I've done in my past, the first time I had counselling it didnt really help, the second time- last year that really helped, and the third time its at least uncovering issues that i've supressed in life.

Dont really know but at the time as i was doing an access course it helped me to judge up the evidence of biological vs family life. I dont know, for me the deeper the problem the longer it will take to become fully functional.


I dont know I really wish I did know the answers, because for some they become immune to drug therapy and the only ulternative is talking therapy, but then that also depends on the problems that the person is demonstrating.

I love Freud, he is one of my inspirations in life along with Einstein.

 

[Wonky]

dib4uk, thanks for being nice to this old bulldog! All I hope for - expect actually on a site like this - is the space for a diversity of views on psychotherapy: from those who think it's the best thing since sliced bread to those who think it is utter tripe, from those who believe they have got something out of it to those who feel that they've got nothing out of it. As I've said before it's the common insinuation that when psychotherapy fails it is actually the patient that failed that gets right up my nose. Good luck to anyone who feels psychotherapy has worked for them, but how about space and respect for those who feel they've never got anything out of it.