So you’ve decided that for whatever reason you need to get some help in the form of therapy. Something has triggered you to realise that actually, you’re not coping great, and you accept that you need some help outside of yourself. This is the first major thing you’ve done to help yourself. But what will happen? Therapy is such a broad term. What can you expect? What will it actually involve? What are the first steps? Well, the first thing you can expect is an assessment.
Most services for therapy first of all will arrange for you to have an assessment call where they will figure out where you fit in their services priorities. This is not to say that your feelings are not important, or that other people’s problems are bigger than your own- do not give in to that mental health comparison trap! Trauma is trauma whatever guise it takes. This is purely to figure out if you or someone else is in immediate danger. Obviously, those who are making plans to hurt themselves or others will be given help immediately- it’s a pure case of safety. I can’t detail what will happen if that’s the case as that’s not my personal experience, but if it is your experience be honest with your assessor to receive the help you’ve called out for. If, like me, there is no immediate danger of harm you will probably follow the same route as myself detailed below.
So, what does the assessment actually entail? There are a number of questionnaires they’ll take you through which will cover various things. First of all, there is a list of questions designed to figure out how your mood is. This is called a PHQ-9 and will determine if you are depressed. You will be taken through some thoughts and feelings and asked to answer the questions based on how you’ve been feeling over the last 2 weeks. I’d suggest keeping a mood diary before this assessment to help you out. I had no idea this was coming, so it’s then pretty difficult to sit and remember how you’ve felt all day every day over the last 2 weeks. The options you have to answer from are- nearly every day, more than half the days, several days, or not at all. An example is “Little interest or pleasure in doing things”.
Next, you’ll be given a different set of thoughts and feelings to mark in the same way from the last 2 weeks, but this time they’re scoring your levels of anxiety. This is a GAD-7 questionnaire. An example from this list is “Feeling nervous, anxious, or on edge”.
Next is an IAPT phobia scale test where you’ll be asked to mark from 0 to 8, with 0 being “Would not avoid” and 8 being “Always avoid it”, a list of situations. These are things like social situations, any situation you think you may have a panic attack, or fear of particular things happening etc.
You will be asked some questions about your employment status- whether you are in employment, and if so what type of employment, e.g. full time, part-time etc, whether you are currently signed off, receive any benefits, or are taking any medications for your mental health.
Finally, there is a work and social adjustment questionnaire where you will mark from 0 to 8, with 0 being “Not at all” and 8 being “Very severely”, how much certain things are being affected by your current feelings. These things are work, home management, social leisure activities, private leisure activities, and family and relationships.
What’s going on for you?
These questionnaires will be the beginning of your assessment, but you will also be asked to share what is going on for you and any other issues you’ve experienced either now or in your past. You will likely also be asked whether you are feeling or have ever felt suicidal. And if the answer is yes you’ll be asked if you have ever made preparations to end your own life. These questions are big and obviously and understandably upsetting. There is something about admitting these things to someone else that makes you realise how extreme your thoughts and feelings were/are/have become.
But I would say to anyone about to face this, to be honest with yourself and with the person carrying out the assessment. If you have got to the point of asking for help, then let them do that. Let yourself receive the help being offered. And the best way of doing that is to be honest so they can work out the best type of care for you to receive.
There are many different options of mental health care available and they will choose the best one based on what you discuss with them so it’s really is important to get it all out there.
A problem shared is a problem halved they say, and while sharing these thoughts and feelings perhaps even for the first time may feel good it can also make things seem very real. You may end up realising something about yourself and the way you are feeling for the first time. You may be dealing with a trauma that you’ve repressed for a long time which will now come bubbling to the surface.
In short, the beginning process for therapy can feel tough. It may make you feel worse before they can do anything to help you feel better, or at least that has been my experience. But the most important thing now that you’ve done the hard thing and stepped forward to get help is to stick with it.
What comes next I’ll step through in further posts as I get my own head around it too.