I wrote this a while ago when the A Day In My Head project was collecting diary entries for a book on mental health. As our computers refused to speak to each other it didn’t make it into the book but I thought I’d share it just to describe some of the agonies that work can bring up.
To give a bit more context than the original word count would allow, we were doing Dialectical Behaviour Therapy. This is an intensive therapy that aims to get a life worth living for people who have difficulties managing strong emotions. As part of starting therapy a few things are agreed with the client and therapist before you can proceed. The one that is most relevant here is the agreement to make every effort possible to give up (or seriously reduce) things that might kill you. The main idea behind this is that therapy doesn’t work if you’re dead. DBT ‘demands’ that things that might kill you are what the session focuses on if they’ve happened in the past week. Due to my feeling (which she didn’t share) that she was repeatedly putting her life at risk, thats all we had talked about for some weeks. This might sound harsh. It certainly felt harsh. What I had to remember was that DBT is an evidence based therapy that we had both freely chosen to try…
I came home from work today feeling useless. I’d been working with someone whose partner has been repeatedly violent to her but she wants to maintain the relationship. She’s keen to get help with her suicidal thoughts, self harming, substance misuse, low self worth and anxiety. She doesn’t accept these issues might be exacerbated by the person you love kicking you around the house. It’s really hard to be in a job where you’re there to help someone, see them suffering, offer help but get told that you can only help with the symptoms rather than the cause. It’s as if she’s got her hand stuck in a mousetrap but only wants help with the pain rather than help to get the trap off. This puts me in something of a dilemma as I either need to pull out and invite her to come back when she thinks her relationship is a problem, or I stay involved and give the impression that you can get a life worth living while the person who lives with you tells you how shit you are and punishes you when you fall below his standards. Which is often. And the standards vary.I feel quite callous when I’m weighing the options up, mostly because I really care about her and hate to see her opting for a life with so much guaranteed unhappiness in it. I know that making changes is frightening. I know that people have always hurt her, so why should she believe things can be different? I also know that she takes massive comfort from SOMEONE choosing to be with her, regardless of how she’s treated. People have suggested that it’s unreasonable to ask her to choose between him and me, but in a sense that’s not what I’m asking. I want us to agree that wanting to live with someone who hurts you is a problem and I really want to help with that. That doesn’t mean that she has to leave tomorrow, but it does mean that a life without a resident abuser is a goal to aim for. As it is, she is really keen for therapy to continue, as long as it focuses on things other than her relationship. This leaves me with a dispiriting choice. On one hand I can stick with her, see the evidence of her assaults, hear her suffering and pretend I can help her feel better about it, which will leave me feeling like shit. On the other, I can tell her that I can’t help her to suffer less with the life she’s chosen, but I will be there to help if she ever wants a life without an abuser in it. She will feel abandoned, and I will feel like shit. It’s a difficult job sometimes. I tend to go to work to help people, so watching them suffer or leaving them when they’re suffering doesn’t feel at all good. In fact it makes me feel quite bad at my job. Rather than abandoning her, I’ve carried her around in my head all evening wondering about the ethics, the effectiveness and the outcomes of both courses of action. The logical part of me wants to respect the choice she’s made and let her get on with it. The emotional part of me wants to rescue her, to help her, to keep her safe. It goes against almost every part of my being to leave someone in that situation. I’m sure “you have to be cruel to be kind” has justified some brutal behaviour towards people in the mental health world. In this case I do feel that telling her why I can’t work with her now but would work with her in future if this issue changed is the thing that would give her the best chance of a better life in the long term. What will be painful for me (and her) is telling her and following through on it. It would be so much easier to just hang in and hope things change. There’s a bit of me wondering why this is what I chose to share. I think I want people to know the impact that the work has, that we don’t skip home at 5 o’clock, that we think and feel about what we have and haven’t done during the day. We talk a lot about compassion in the NHS, but being compassionate isn’t always doing what people ask for.
I shared an abridged version of this story while having a conversation about people experiencing domestic violence being intensely miserable on mental health wards. Staff acted as if they were ill rather than having a natural reaction to prolonged suffering. I got the feedback that I was a misogynist with a worrying attititude towards domestic violence. I’ve thought about that comment a lot and it’s probably done more than anything else to inspire me to write this down. In truth I’m not sure if this vindicates me or makes my hole a little deeper. Perhaps it’s worth adding that if I had done what I think would have been most useful (stopping working with her until she agreed that living with someone who might kill her was a problem) she would still have had support from the CMHT, she would ‘merely’ have lost a therapy that prioritised getting things that could kill you out of your life.
I wish there was a nice tidy ending to this story. In the end I changed jobs and she transferred to another therapist. I don’t know how life turned out for her but in my head when I think of her I tend to see her smiling before being beaten. I’d like to think that things turned around but thats purely based on hope. There’s nothing I can hold on to that suggests things would improve. She’s now one of the people I carry around in my head. I wonder what has happened to her and whether I could have been more helpful. Helping someone to stay in hell seems wrong while leaving them there to burn in the hope it gets too hot seems wrong too. Maybe sometimes there just is no good option…
Let me know what you think,
You can get the full book of A Day in my Head packed with many better entries than this here-
A day in my head
by Aron Bennett