Understanding and accepting where you are at - SHORTS

“The difference I have noticed is that this time Jo has just accepted things before events like school provision collapsing and leaving a job would have resulted in self-blame, loss of confidence and rapid deterioration in mental health.”

My husband commented on this during my review appointment with my psychiatrist at the weekend. It crystallised my thoughts and feelings that I have coped well with the turbulence of the last few months because I have learnt to accept that, in my words, “it is what it is.”?

In this newsletter, I want to unpick how I have reached this point. How did I reach the point where I can now accept external events and their impacts more rationally and logically?

It can be easy to say – you must accept things and move on – but I have found that this is something that my autistic and bipolar mind has often struggled to do despite my good intentions. For me, this journey to understanding and acceptance started two years ago when I finally accepted that I needed to try talking therapy again.

Reaching rock bottom

Two years ago, in January 2023, I had finally been convinced that finding a new therapist was essential if I wanted to break the cycle of recurring long periods of depression. This was after a rather fractious review meeting with my psychiatrist in late December 2022. Turbulent external events had calmed down in the last couple of months. “There’s no reason why I should still be depressed” I complained.

I had been looking for the magic bullet. I thought there must be a different medication suggestion that would ‘fix’ the depression for good without me having to engage in therapy again. Eventually, I was persuaded to give it another try.

What makes a good therapist?

From my experiences over the years, I have realised that a suitable match and connection between therapist and client is the most crucial element to successful therapy. Someone may be a good therapist, but the key is:

1. Finding a good therapist for you.
2. The timing of receiving the support.
3. The length of time support is available.

I have worked with my current therapist weekly for nearly two years. I am fortunate that our family finances allow us to afford this level of intensive support. I have benefitted from working with someone who has sufficient knowledge of my circumstances and who has observed for themselves the changing patterns of my thoughts and moods.

Whilst this may not be necessary or desirable for many people, I don’t think there would have been a shortcut for me.

The challenges of finding a suitable therapist

Finding a good match is no easy feat; you will have minimal choice unless you can pay privately. Unfortunately, mental ill health does not always obey such restrictions as will be imposed by accessing therapy via the NHS or your employer. From my perspective, it is short-sighted and counter-productive that support is often terminated as soon as someone appears ‘better’. However, some support is likely better than none, so getting access to whatever you can secure is worth it.

Being able to afford private therapy gives far more choice and control. Still, I recognise this is an enormous privilege and will not be accessible to many who could benefit from it.

Past experiences with therapy shaping future considerations

I had talking therapy via the NHS back in the late 2000s, and that was very helpful when provided by the Primary Care Mental Health service, accessed via my GP. It gave me some strategies that I still use today. By chance, that therapist was a good match for me.

I had a private CBT therapist for a short period whilst waiting to get back on the caseload of the Primary Care Service at one point. Whilst I found that initially helpful, moving my mood from very low to improving, I found it too prescriptive and less useful as time went on.

Long waiting lists for support also mean that you don’t necessarily receive the support at the right time for it to be most effective. The last NHS counselling that I was able to access was in early 2018; the counselling sessions did not start until 3-4 months after I had referred myself.

Later, in 2018, when my mental health dipped again, I had a private counsellor for just over a year. Longer term, I found it ineffective. In hindsight, that counsellor was not a good match for me.

My previous history of talking therapy not being that effective in helping me manage my recurrent depression had made me reluctant to try again. Prior experience did, though, at least make me more careful in choosing my next therapist. I knew what I had found helpful and what hadn’t been effective. I considered what I was looking for more carefully and had an initial conversation with three therapists before deciding to proceed with one, a pluralistic therapist.

The challenge of engaging a therapist when depressed

When I was feeling depressed, finding and securing the services of a new therapist took an enormous amount of effort. Perhaps this is where autistic tendencies impact too – deciphering therapist’s qualifications and specialisms, understanding the language used, taking that step to reach out with an enquiry, have I put myself across correctly, what will they think of me? It all takes a significant amount of mental exertion, and there is a lot of demand avoidance.

This is why imploring people to ‘reach out for help’ at their lowest is a double-edged sword. Its demands may be too much for someone to manage at their lowest ebb. When severely depressed, you start to lose hope that anyone can help. The more episodes of ill mental health I experienced, the worse this feeling got.

This is why reaching in and sitting alongside is so essential. Only I can make the changes and engage in support that might be available, but assistance to find that and receive support and encouragement along the way can be essential.

For more information on the different types of therapy available and finding a therapist in the UK then, the British Association of Counselling and Psychotherapy (BACP) has valuable information - https://www.bacp.co.uk/

The benefits of talking therapy

Despite the reservations I have expressed above, talking to anyone independently can have enormous benefits. A counsellor is trained and practised in listening in a nonjudgmental way. They have no other investment in any discussion and no ulterior motives. This unique position will not be available to anyone you know, such as family, friends, employers, or co-workers.

Although the therapy I had done before did not help me to manage my mental health effectively over a long period, each depressed episode and therapeutic intervention did reveal things to me that I would otherwise have been unaware of. So, if you can access therapy via the NHS or an EAP, please use these options.

For those with more complex needs, including those who are neurodivergent or think they might be, talking with a GP or other professionals involved with you to talk about options would be best. I want to point out that reaching out for recommendations from others with similar circumstances, either online or in person, could benefit you. You can also now search for therapists and coaches who are neurodivergent themselves -

https://neurodivergentpractitioners.org/

https://ndtherapists.com/united-kingdom/

For specific guidance relating to autism and mental health, please see the recently published Autism and Mental Health guide from the Royal College of Psychiatrists - https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/autism-and-mental-health

How did therapy help me to understand and accept where I am at?

In January 2023, I started working with my therapist. I was not at my lowest point, which I had probably reached during October-December 2022. I was still depressed, however. Over the weeks and months that followed, as my therapist learned more about my circumstances and recent history, he helped me appreciate the understandable impact recent events had had on me.

It allowed me to reflect on those experiences, consider their impact on me and my relationships at the time, and consider how they still impact me. Before I had the time and opportunity to describe what had happened via therapy and reflect on how that made me feel, I didn’t realise the significance of the enormous storms that I had experienced, nor had I been able to see where waves had overcome me because of external events.

Those closest to me had lived through the experiences with me, but I didn’t share all my feelings and thoughts with them because that just wasn’t in my nature. I tend to look out for others first and avoid offending, putting my needs aside. On the occasions when I did try to prioritise myself, it tended to come out all angry, upset and wrong, resulting in arguments and causing more hurt for myself and others.

From early 2020 through to early 2023, I experienced a rollercoaster of events and different circumstances, and I can see with hindsight how my unidentified bipolar patterns were particularly prevalent. This included issues with every aspect of my life - work, home, family and friends - all against the backdrop of the most unusual and unprecedented event in my lifetime, the impact of the COVID-19 pandemic.

Understanding how events impact me

When I went to that review meeting with my psychiatrist in December 2022, I presented things resolved and sorted in terms of external events and their impact.

Undertaking the talking therapy over the last two years since then has helped me to understand the impact of all these events, particularly the impact of the grief from the loss of my sister-in-law Helen to cancer on all of us as a family. The impact of that was and continues to be huge. It impacted all my closest relationships and put a significant strain on them.

My husband has always been my anchor and most fantastic support during my periods of ill mental health. Now, he was dealing with his grief, alongside supporting his mum, brother-in-law and nephews, and maintaining a stressful and demanding full-time career. I was initially hypomanic, in an organising and sorting phase, dealing with practicalities on various fronts.

When that initial involvement with others and the need for immediate action tailed off, I struggled to deal with my grief; our children’s needs seemed ever-growing. I worked part-time in an office while trying to maintain and find funding for Actually Education. It is no wonder that I, and my relationships with those closest to me, suffered under the strain.

Understanding my triggers and what I want and need

These recent events haven’t occurred against a blank canvas. I was already dealing with a severe mental illness, bipolar, and I have been autistic since childhood, although neither was identified clearly until the summer of 2023.

Perhaps most impactful for me over the years in terms of impact on my mental health is when I am unsure of my status and role in life, uncertain of what I need and want. When I lose confidence and belief in myself and my purpose, that tends to impact my closest relationships negatively. That affects my ability to access their support to help me identify my role and purpose when needed.

One of the first questions my therapist explored with me in early 2023 was what I want and need. I honestly couldn’t identify anything that I wanted or needed! I just wanted not to be depressed anymore and to be happier, but I had no idea how to achieve that.

Therein lay a big problem for me in my relationships with others. I couldn’t communicate my needs and wants to others if I didn’t know what they were myself.

Understanding what I want and need has taken much talking and unpicking. Then, I did a lot more work on communicating those to others and understanding others' wants and needs to better meet them. Therapy over a long period, and even initially from the outset, has helped me identify things that trigger an overwhelming emotional response in me.

In our weekly sessions, I recounted small events and occurrences from my daily life. We identified common recurring triggers and worked on a few strategies I could implement. Much of this focused on how I interacted with those close to me and what impacted those relationships.

Will I always need therapy?

I have continued with weekly therapy even during the longish period since April 2024, when I felt mentally more stable and balanced. I find having someone independent but with a thorough understanding of me, recent events, and the background to situations I am talking about invaluable.

Outside of therapy, I talk more now about my thoughts and feelings with others. Writing and talking about things in my therapy sessions helps me formulate and process what I am feeling and thinking and how that impacts my behaviour differently. That aids my communication elsewhere.?

Through regular therapy, I and those close to me can spot signs of me veering towards either depression or hypomania in the early stages when it is easier for them to reach me and for me to make necessary adjustments.

I see the support I have around me now with close family, peer support, psychiatrist and therapist as being long-term fixtures in my life for the foreseeable future. I may not always require as much intensive professional support as I need currently. Still, my mental health is always something that I feel I will need to actively manage to stand the best chance of maintaining as much balance and stability as possible.

Changing the world on my terms

In 2022, my husband implored me to concentrate on our family instead of trying to change the world. At that point, I didn’t really get where he was coming from; I thought I needed to change the world first to benefit my family.

Now, I have recognised and put all my efforts into focusing on what I and my family need and trying to effect changes that need to happen. Hopefully, these small, micro, and local changes will also change the world.

About the author

I am Joanne (Jo) Feaster, a late-identified autistic and bipolar woman. I started self-identifying as autistic in May 2023 and was diagnosed with bipolar type 2 in July 2023. I am married and live in Leeds with my husband John and my two exceptional children, both of whom were diagnosed in late 2023 and early 2024 as autistic and ADHD.

I write to aid my mental health and to share my lived experiences as an autistic and bipolar woman and parent carer of my neurodivergent children. I subscribe to the social model of disability and the neurodiversity paradigm. I see our strengths, positive qualities, and spiky profiles just as much as I recognise the barriers we face from society.

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