Tag: care coordination

A much bigger loss than they realise

When I signed up to the programme of treatment I am in at the moment, it was to include weekly group MBT therapy, fortnightly individual therapy, monthly care coordination and support available from a duty team.

With no warning, monthly care coordination has been stopped and changed to quarterly. Having expected to see my care coordinator yesterday as we’d previously booked, this was cancelled and my next care coordination is not to be until the end of September, which will be about 4 months since my last appointment.

I could write a lot about how badly the actual communication of this decision has been handled. Actually I did but I deleted it. It probably doesn’t do anyone any good, not me or the service or anyone else, to shoot off into an angry tirade. I’ve been trying to process this through since we (ie all of us in the therapy programme) got letters telling us a few days ago. My emotions are pretty out of control and shooting to extremes at the moment independent of this which is making things harder – ironically, partly because there is so much going on all across my life and I can’t hold it all together; I could have really done with some help from my care coordinator. I’m trying not to just rant in anger here. However, I do think that some of my feelings are shared by other people in the programme and I do think this reduction in appointments is a much greater loss than the hospital realise. There is a huge gap in care here and it’s getting wider.

We weren’t involved in the decision. We were informed afterwards in an impersonal letter. We were informed that this would be best for us. There was nothing personal about the decision. Surely everyone’s needs in terms of care co-ordination may be different, at different times in their therapy, according to what’s going on in therapy, their health across the board, and all areas of their life? The approach being taken isn’t responsive. It’s just a blanket decision.

My views are certainly being influenced by what I observed and experienced when I worked in mental health services in the same mental health trust in which I’m now treated, but I wonder if the source of this reduction in appointments is actually largely to do with funding cuts and staff shortages? Conversations I’ve had with my care coordinator have given me more than an inkling that my suspicion is correct. If this is so, it would have hurt a lot less if this explanation had been given plainly, rather than it being couched in claims that the service think it’s better for us to have less coordination of our care.

Leaving this aside, nobody actually discussed the matter with us whilst deciding what would be best for us. We didn’t get to give any input about why care coordination is important for us, the help we need, the effect this withdrawal of support would have, what our needs are and how they might best be met. We committed to the therapy programme expecting one thing and now this has been changed. We’re expected to stick with the programme and commit to it but they are free to change it how they choose. This is by no means the first time this has happened and what we have trusted in has been changed or taken away. Support we desperately needed, which was insufficient anyway, has now been withdrawn further.

All these things combine to make us feel hurt and powerless and unheard by those we should be able to trust and undeserving of support. I posted yesterday about how when I discussed the changes on the phone with my care coordinator (after I’d chased several times for any explanation of how the decision was made and what’s happening in practice with my appointments going forward) he told me the service thinks this is the best way to challenge us to be more independent, and how much this hurt and how little the service we should be able to trust actually appreciate what we are facing.

Separate from the emotions this brought up, the withdrawal of these appointments doesn’t just affect the appointments themselves; by the very nature of what care coordination is meant to do, it will have an impact on our wellbeing across the board and I think this is where the proverbial baby well and truly has been thrown out with the bath water. It seems the clinicians who have made this decision do not realise what a loss this will incur.

First, on an immediate practical note, it will have a knock on effect on our therapy appointments. We have been told that the clinicians have decided it is most appropriate for us to get help in therapy appointments rather than care coordination. The focus of a care coordination appointment is utterly different from a mentalisation-based therapy appointment . Therapy appointments focus on emotions and interpersonal situations, looking in depth at particular relationships and specific interactions, our emotions and thoughts and our understanding of what is in our own and each others’ minds. It’s not so much about events and information and our circumstances as focussing in depth on our emotional experience and thought patterns. This is totally different from what is covered in care coordination – such as building a care plan, reviewing mental and physical health, looking at input that may be needed from other health professionals or support workers, looking at social and financial problems and stability, monitoring risk and safety issues, communicating with the range of professionals and others involved in someone’s care… the list goes on. If this is now to be squashed into the therapy appointments, either the time for therapeutic work will be greatly reduced or the problems we needed care coordination for won’t be addressed.

This is all the more important since the length of time for which one can be seen in the service is now strictly limited. The service was set up to be a lifelong service, recognising the fact that we may likely need help outside of particular therapy programmes across many years. Now this has been stopped and after we have completed a particular therapy course we are discharged whether or not we are coping or safe or recovered. When time is limited and so soon we will find ourselves alone again or at least without specialist support, whatever state we are in, it’s all the more important that whilst we are with the service we can get help pulled together across all the areas of our life that our mental health affects and that affect our mental health.

And these areas are broad.  Several of us in my therapy group, myself included, have multiple mental and physical health diagnoses. Most of us have many unmet needs at any one time.  Some of this is because of rules that you can only be seen in one service at one time. I’ve posted before on how unfair that can feel – for me one thing this rule means is I’m not allowed any help with my PTSD and trauma following the abuse I’ve been through, because I’m being seen in the PD Service. I know other people who were forced to choose between being treated for their life threatening eating disorder or their personality disorder. Multiple mental health diagnoses are often closely related but I, and I’m sure many others, have had big difficulties trying to find the way through the care and treatments they need and I’m regularly promised help that is then the next minute taken away. Someone needs to pull all this together and make sure communication happens and that help promised is actually delivered. It is too hard to do this on your own when you’re seriously ill and all too often you are bounced between different services, each telling you that another service is meeting your needs when actually nobody is.

Physical and mental ill health tend to cause disturbance and instability to a lot more than health. Just a few examples from my own experience – and all these are shared by other members of my therapy group – are losing your job, being made homeless or having to move from your secure home, having nowhere stable to live, having no money to meet essential expenses of food and rent and bills, falling into debt, trying to navigate the system to claim sickness benefits or help with housing costs whilst working part time – and being met by mistakes and delays at every turn and waiting weeks on end to receive any money, consequent trouble with utility companies, landlords, over or under payment of tax and Benefits, filling out form after form, having less and less contact with friends and having no resources (financial, or in terms of emotional strength) to keep in touch with the little positive things that can keep you well, relationship breakdowns, addiction, crises, losing control and ending up in trouble with the police or other involvement from emergency services… I could go on and on.

It just isn’t possible to sort out all of these things on your own especially when you’re struggling with the daily pain of the BPD itself. You desperately need someone to get you access to help and guidance, to be familiar at least to some extent with the systems you’re struggling through and to know what help is available and refer you there. This help has never come, for me, from the PD Service, and with so little care coordinator input going forward, it’ll be even scarcer.

Yes, a lot of these things are parts of everyday adult life but the fact is by the time most of us eventually get seen in a specialist service like mine, we have struggled without the help we need for years upon years and are very near the end of the road. (Potentially, very near ending our lives, or already having reached that point because there is nothing but pain, dark, utterly spent, utterly trapped, self disgust, I could go on…) Yes, we have to be able to function independently. But we are silently screaming how right now we can’t. We need help. We desperately need to be heard that we need help. Every time we have tried the very hardest we can and there’s yet another loss, obstacle, more and more piled on us, our risk increases and we are less and less able to be independent and more and more locked into our compulsions to overdose and self harm and try to numb and control the utter desperation and silence the painful scream for help inside us. If someone hears us, guides us, gets an understanding of what is happening across our lives, pulls the pieces together and gives some continuity, as our care coordinator could, then we can start to gain strength and start to find some kind of stability that might eventually allow us to heal.

I am incredibly fortunate that I have a support worker (from a local social service, not from the NHS) who is helping me with so many things that I’d have hoped my care coordinator and/or support workers from the PD Service would have done. The response from the PD Service was to brush me off saying everyone has to deal with these things and I did not qualify for any help and one appointment with a care worker who did not know anything about most of the areas in which I needed help. Thanks to my current support worker, I have not been evicted by my landlord, I have been helped to fill in the complex application forms for disability benefits, I have had support to go to assessment appointments, I have had help learning to budget, I have been able to access the correct advice and information from all the services involved (housing benefits, the council, the Jobcentre, disability services etc), I have someone on my side who understands the difficulty I’m going through at the moment in the police investigation into my abuser, and I have some social support which will help me use my time constructively to keep getting better and eventually learn how to get back into work.

In no way did the lack of recognition, lack of coordination and lack of support I received from the PD Service make me better or more able to function. In no way has having a support worker made me less independent or worse. I am now self harming much less and have not overdosed for weeks. I’m able gradually to do a little bit more and then more, because I have some sense of stability and safety and someone who believes me. With his support I’m not alone going through the things that distressed me to the extent that I couldn’t cope and could only hurt myself.

This support is desperately needed. It is very sad that it is so hard to find. Given that the therapy programme is so good, and I know it is such a privilege to be able to undertake it, it is sad that the support towards staying safe and being well and stable, is so lacking. It is much harder to grow and make use of the therapy from a place where you don’t feel safe or heard.

Perhaps I’m overreacting. Perhaps I’ve had an unusually bad experience with my care coordinator or when I’ve been in crisis. Perhaps I’m incredibly dependent. (Well, I think I definitely am.) Probably I should focus more on the fact I have the support I do. I know many services have much less support available. It just seems to me like a big and widening gap and that things could so easily be different.

If I recover enough to ever work or volunteer in this field, I’d like to work on trying to bring together patients’ access to the support that’s out there and bridge the gap of all the unmet needs that are stopping us from having a stable life whilst we’re working through our therapy programmes. I’m sure this would increase people’s security in their recovery.

Ginny xxx

What you aren’t allowed to admit – the shameful secret that I want to be cared for

The service where I am in therapy at the moment has suddenly (from our point of view as patients at least) changed our care coordination appointments from monthly to quarterly. Less than quarterly, in practice. I was supposed to see my care coordinator today. The appointment has been moved to the end of September. This will be 4 months since my last appointment at the start of June. This comes at a time that I desperately needed care coordination and when everything feels on the edge of fragmenting.

I am furious at how this change has been made, for myself and for other people in my therapy group. I’ll post about that next.

I spoke to my care coordinator about it on the phone and one of the most hurtful things that he said was that this has been an “ongoing clinical decision over several months” and they think this is the best way to challenge us to have more independence because instead of having a care coordinator we’ll have to take the initiative to sort out our problems. I’ll set to one side for the time being the hurt caused by having been kept in the dark, not warned, let alone involved, in the “ongoing decision”; the apparent total lack of awareness of why care coordination is needed; the assumptions about knowing what is best for us….

One thing that really really hurt and I wanted to scream and felt utterly betrayed again by the people supposed to help me and understand me was – we do not need a test, or a challenge, or to be forced to be “more independent”. We desperately need to be heard and to get help. I have been in this service since November 2014 and I am still screaming inside and falling to pieces and trying to be heard over the same issues as when I first came to the service. We have always been on our own. We have had to do everything with no help and knowing everyone will leave us. We just start to trust this service and dare to think perhaps they’ve understood a tiny bit of what it’s like, and then we get proof it was all an illusion. Never in my whole time with the service have I felt safe, been kept safe.

And here comes the thing it’s so very shameful and not allowed to admit. Sometimes – even a lot of the time – I don’t want to be independent. I want to be heard and I want to be cared for. The abused and terrified and frightened child inside me has never ever been heard or believed and has never been cared for. I have fought and fought on my own and I cannot do it anymore. I need help. I can shut up the child for so long by cutting and starving and drinking and overdosing. But there is a point of breaking. And I’ve passed it. I’ve never been safe. Never been safe from my abuser. Never been safe from what goes on in my mind, the pain, the hallucinations and flashbacks. 

I know these feelings aren’t allowed. We have to take responsibility. We have to be independent. We have to be adults. We have to function.

Is it so very wrong to want to be kept safe? To want someone to hear and know how utterly painful it is? To want someone to care for us? To want someone to stick to what they agree to and not trick us, not tell us they understand but then leave us alone when we most need help? If I am not independent is that really the most important awful thing? Why should I not be allowed the help I need because it’s so desperately important I be independent? Nobody kept me safe as a child. Nobody cared for me. Over and over again my abuser tricked me and left me powerless. The service I should be able to rely on now in my treatment, to understand and help me, makes me feel the same. In no way is it an empowering kind of being made independent. It’s being pushed away and tricked and all the cuts made deeper still.

I’m ashamed to admit it but I want someone to care for me. Before I can start to get any more ability to cope on my own I desperately need someone to understand how loud I’m screaming and how much it hurts and not to leave me, hold me and stop me from falling to pieces, stop me from losing all grip on reality because the pain and terror is so utterly consuming, hold me and allow me not to be okay. Then maybe I might be able to take very gradual steps to take back responsibility for one thing at a time. I don’t need to be tested, tricked, pushed away, not believed, not heard, used over and over again and taken to the most vulnerable desperate point then what tiny little things we hoped in taken.

I am full of anger and pain and rage at being tricked and used all over again.

G.

Not my day off

Today has been demanding. It’s one of those days that seems too much to have been only one day. I got big stuff done but also I’m losing time in unsettling ways and I know I was dissociating a lot between the different tasks and meetings I had to do, slipping out of being engaged with what’s going on and what I’m feeling and struggling to come back. Nevertheless I got through quite a few challenges.

Last night I knew I needed to tidy and clean my flat. My support worker was coming today. Also I hadn’t been on top of the housework since my operation and it was bothering me more and more. Recently I’ve started to find a greater sense of order and calmness if I don’t have too many things disorganised around me. This is interesting because til now, I’ve tended towards accumulating things I don’t need and not being able to keep my house ordered, not exactly hoarding but not being able to face items and paperwork and household tasks without going into panic.

Yesterday I was very anxious about today but put some of the physical drive from the anxiety into cleaning and then went on to clearing out some of my cupboards. By late evening I’d cleared 7 big bags (between rubbish and charity shop) and set 3 more big bags of things to try to sell at a car boot sale. The fact I don’t have a car for the boot element of that plan is potentially problematic 🙂 but there are the odd few table-top, largely indoor, sales in community centres / church halls here in the summer and I’m hoping I can find one to join in.

Today was a struggle to get up. Everything hurt. Still, I got together the papers I needed to show my new support worker (more on this tomorrow), then it was off to my care coordination appointment with my CPN. This wasn’t easy to go to because, although my last appointment was okay, in the two previous appointments I’d been really distressed and felt I didn’t get heard when I was desperate and at risk. Today’s appointment was actually really good. We looked at some DBT skills and we did a review which was overdue (every 6 months or so is a review appointment). I’ve not yet felt able to discuss with my care coordinator exactly what went wrong in the difficult appointments earlier this year when everything was going to pieces. I’m scared I’d lose control and the feelings of anger and not being believed would return and I’d do bad things and be back where I was. However my care coordinator and I have managed to move forwards having 2 positive appointments. I was scared after what I’d done – how upset and angry I’d got – he wouldn’t believe me or want me anymore and they’d know how bad I am and that I didn’t deserve help. That hasn’t happened. That’s something that I don’t usually get to experience.

Straight after my care coordination I met my support worker, H., who is from a housing support charity I was referred to recently. He is going to help me sort out my benefits like Housing & Council Tax Benefit, Tax Credits and disability benefits,  as well as liaising with my landlord about the rent arrears that I got into when I lost my job last year. It was a long appointment. We went through the background to how I’d got here, financially and in terms of my health, and we looked at lots of documentation, my income and my benefit and Council Tax notices. This took a lot out of me and I came so close inside to panic and losing it and emotions shooting too high. H. was very calm and non judgemental, which helped a lot. (More on this in the next couple of days.)

Then I had to rush to my GP appointment, which was the first since I’d been very distressed and angry at the surgery a couple of weeks ago;  also the first since my operation and finding out endometriosis isn’t actually the explanation for my pain and gynae issues. I’m still working through what happened in today’s appointment. I was dreading going into the surgery because I’m still terrified of what I did and how much I lost it. I was ashamed and embarrased and knew that they probably didn’t want me around again. I knew I’d really upset and inconvenienced and disturbed people. I’d scared people. That’s the worst thing,  the harm I caused, the bad I’ve always feared getting out of me. Talking to the GP  and discussing what happened and then also talking about my physical health was really emotionally charged.  It’s hard trying to deal with a lot of uncertainties about my physical symptoms. I know not having endometriosis is a really good thing but not having any explanation for all the things I thought it explained, and the fact the doctor isn’t really interested any more in investigating what may be wrong – well, that’s hard and triggers all my fears that it’s all in my head, I’ve made it up or I’m mad, it’s my fault. …

After the GP it was off to the pharmacy with my prescription, then finally home.

It’s been quite a day. I had a soothing bath tonight. Today was the first day I could have a bath since the operation (don’t worry I promise I did still wash 😉 !). The doctor sealed the wound with dissolvable stitches so it was important not to soak them in water too soon or they could have come undone. Also it was not safe to try to get in and out of the bath whilst my mobility was further reduced with post op effects. Falling is a risk for me anyway because of the problems the fibromyalgia and arthritis cause in my legs. So, tonight was a good little relaxation and refreshment. The little things do help!

How has your day been?

Ginny xxx

 

Trying to be curious about trust #1

As you may know if you stop by regularly ( 🙂 thank you lovely people!!) I’m finding it very hard to trust the personality disorder service at the hospital (where I go for therapy) at the moment. It has become harder and harder over the last few months, in part due to repeated occasions where, in my experience at least, I’ve been let down, not had the promised support, or been turned away when in desperate need of help. I feel they do not believe me and do not think I deserve help and the more I’m in crisis the more they don’t believe me. Everything that happens confirms this now. In my last care coordination appointment I felt again completely dismissed, not listened to and that what was recorded on my care plan did not reflect what I was going through or needed, until I’d insisted time and time again that my care coordinator write what I actually said rather than re-phrase it in a way that minimised and avoided a lot of the issues at stake. Aargh….

I can’t explain it more than this right now because I will get so angry and out of control. Plus you’ve all probably heard me go on about it so much you’re bored 😉 ! Sorry.

I’m trying to be curious about my feelings about trusting the service and how they see me, as Mentalisation Based Therapy focuses on this and trying to be curious and open to different feelings and uncertainties about what is in our mind and other peoples’.

Right now, although I can try to examine different possibilities, I’m certain in my heart that the service don’t believe me. This doesn’t apply so much to my 1:1 and group therapy sessions. In some way the group feels honest and safe. Perhaps it’s something to do with my commitment being to the other people in the group, listening to them and being there for them, present with them, and sharing honestly as much as I’m able, rather than it being a relationship just with the service or the therapists. It applies more to when I need support between sessions, or when I’m in crisis, or talking about support outside therapy with managing daily life, or in my care coordination appointments.

After the experiences I have had so far, I am not sure what would now reassure me that they did and do believe me and do want me. I got on to thinking about how my recent falling out with a close friend N. involved my absolutely unchangeable feeling that she didn’t believe me, didn’t really want me, didn’t think I deserved help, and I was just a burden and irritation. I don’t know what would convince me otherwise (except, just perhaps, if she had come to help me when I was at my worst, in some of the times she was adamant she could not or should not come).

Not being believed and not deserving help is a big theme for me. Ultimately, I do it to myself too, because I can’t really believe myself. Some of my psychotic symptoms feed into that, with the voices in and outside my head telling me I’ve lied, I’m a fraud, that everyone knows and is thinking and saying I’m a disgusting fraud, cheated people to get help, and no matter if I may think I want to be good and try to do good, there’s all the bad things in me really and everyone else knows and I’ll hurt everyone in the end. Only self-harming in some form quiets this.

In my last 1:1, we talked about my recent falling out with N. We started going slowly through my feelings and thoughts step by step from the beginning of the day things really fell apart between us. We didn’t get very far through. Nevertheless it brought back a lot of the feelings of that day. I’d been feeling very bad about things I said and how things were left at our meeting and in our exchanges the week after (since which, we haven’t been in touch – I couldn’t anymore and felt she didn’t want to either, really). I’d been trying to write to apologise. But in the 1:1, what was even harder than this was that guilty as I felt (and still feel), a lot of the hurt is still there too.

As the memories of these feelings, and more of the feelings, surfaced in the 1:1, I suddenly felt sure that my therapist must think I’m a horrible, childish, needy, jealous, selfish, demanding, nasty person who thinks terrible things about people. Then I started thinking these things about myself together with feeling guilt, disgust that I was so evil, and worry about what would happen to my relationship with my therapist now she thought these things – I couldn’t say what I thought would happen at the time but now I think it was feeling that, oh now she’s started to realise that I really am bad after all and she’ll leave me and not want me around any more.

I was certain about what my therapist must think. Just as I was/am certain about what N. thinks about me. It was actually very hard for me to think curiously about what N. (or my therapist for that matter) would feel. I spend a lot of time certain and horrified about what the people I’m interacting with think about me, and feeling bad for what I am (because of what they’re thinking), what I cause, and the feelings that are then in me, confirming my self-disgust and self-hate. My self identity is somehow, in a way I can’t yet express properly, bound up with what I am certain the other person is thinking about me. My own feeling follows immediately being so certain of their thoughts. I am not necessarily at all able to access beforehand what I am feeling, and I am not necessarily able to think about what the other person is feeling (separate of me, as opposed to being convinced about their thoughts about me).

I am not necessarily bad at picking up what other people are feeling. Actually, I can be very accurate in it, and sense it before other people do. I’ll post about that separately and will put a link here when I’ve posted. However, in these situations, I’m entirely sucked into the certainty of their thoughts.

I am not at all able to “mentalise” – to reflect and be curious about what is in their minds and what they are feeling and what I am thinking and feeling. There is no possible questioning or genuine entertaining of different possibilities about the other person’s mind. I am absolutely certain of their thoughts about me and I have absolutely certain thoughts and feelings as a result. Even though I may at some level be able to come up with a distant idea of other possible thoughts that could be in the other person’s mind, it is completely disconnected from my beliefs and emotions.

Written down like this, it is quite easy to see that this could lead to or be part of my psychotic experiences. I am certain of other people’s thoughts about me. The voices repeat them to me. I feel disgust and guilt and horror of what I’m doing to people. Somehow I become linked with the thoughts I think the other person is having and I am all those horrible things.

I am starting to wonder whether I am actually having the thoughts (which I attribute to the other person) myself, and having the resultant feelings myself, but I am unable to recognise them or feel them in myself, and then for some reason attribute them to the other person as though I know for sure that they are thinking these things. Really they are just my own thoughts or feelings about myself.

Perhaps my certainty nobody believes me or wants me and my resultant inability to trust, is in fact simply nobody else’s thought but rather just what I think of myself – and the fact that I cannot trust or believe myself because I always doubt my own motivation for good or evil, because I have no identity except what I find in what I think are others’ thoughts.

I don’t know quite where this came from. Certainly my mother’s very unwell beliefs about thoughts and emotions during the time I was growing up, clouded my learning about my and others’ feelings and thoughts and the demarcation between them. Her deeply psychotic beliefs were pervasive and persistent. She believed that I knew exactly her thoughts even in advance and when I did not, she told me this was deceptive; she believed she knew my thoughts and intentions; she frequently presented to me my intentions as malevolent and manipulative in incredibly complex ways, when I was unaware of any such motives or thoughts (precisely because they didn’t exist, but I didn’t know that as a child); she made inconsequential, morally neutral actions (such as being able to do some particular thing or not) have a moral value or manipulative power (“repeatedly punishing her” for example); she perceived my emotions as controlling her and done to her (unless they perfectly matched hers); and this was coupled with dire threats (including her suicide, my father’s death, the family breaking apart, my parents being taken away) because of my emotions and thoughts – and of course, with the abuse.

I don’t know quite how to unpick that to find out how much does it explain how I now feel about others’ thoughts about me. Maybe I don’t need to and just need to find out how to change my certain, set-in-stone thought patterns now.

Oh my days I’m tired now and I need a hug. Think I’m going to have a hot bath and curl up under my blanket when I get home.

Ginny xxx

Scared I’ll lose it again

Tomorrow I have my usual weekly group therapy, then I have my monthly care coordination appointment (it’s supposed to be monthly but has been canceled more often than not since October last year). It’s challenging at the best of times when this appointment comes round, especially when it closely follows therapy group on the same day, which is draining in itself.

I’m very worried about the care coordination tomorrow. Last month I was really upset and desperate in the appointment, didn’t get the help I felt I needed to stay safe and left wanting to end my life and overdosed. There was a complete lack of understanding between me and my care coordinator.

I’m scared something similar may happen. I’m scared that I might lose it like I did a couple of weeks ago. I’m so so ashamed of that and I feel dread when I think of it. I’m scared I won’t be able to control what I do and it’ll happen again because I’m so unstable right now, flicking into distress and hurt and anger so quickly.

Also, I’m scared because there are really difficult things I want and need to say. I can’t say everything’s good and fine or that I’ve made progress; I can’t say I think I have the support I need because there are massive issues and have been huge failures in communication and so many things promised have not been acted on. I now operate by expecting nothing from the service and expecting whatever is arranged not to happen. It’s “safer” that way. It doesn’t open me up with hope and trust then twist the knife with another let down or betrayal. It means I don’t ask for help either.

I need to communicate these things. I never do, usually, but if I don’t there’s no going forward. So I’m going to try to say at least some of them and write a letter as well in the next few days.

I do not know how to stay calm whilst I do it. How do you stop yourself losing it? How do you control the aftermath of feelings without harming yourself? How do you keep your emotions level when things that are really deep hurts to you, are unanswered or ignored?

I’d be seriously thankful for any suggestions!

Ginny xxx