Seventeen year old Katie sat uncomfortably on the old green velvet sofa in my office, with a look that reminded me of a rabbit caught in headlights.
Eyes wide, she described how her mother had encouraged her to go and see her GP when she discovered that Katie had been self harming. The GP had suggested she might have bipolar disorder and arranged for a formal assessment.
Katie was now very frightened indeed. ‘If I’m bipolar, mum won’t let me go to university and live away from home. My whole future is wrecked. Why did this have to happen to me?’ she sobbed.
Whilst waiting for the formal assessment, Katie’s mum had also helpfully suggested she come along for some therapeutic coaching. I was glad she had. My encounter with Katie was to prove life- changing for her.
‘Am I some kind of mentalist?’
‘What were the symptoms you reported to your GP’ I asked Katie.
‘Well, sometimes I’m really down and don’t have the energy to even get out of bed in the morning and other times I’m jumpy and on edge. I’m restless and up all night. I can’t sleep. I can’t seem to concentrate either and my memory’s really bad. I’m so forgetful.’
‘When did this start Katie?’ I asked.
‘I was absolutely fine until about two years ago’ Katie replied, thinking hard, ‘and then the anxiety started. The cutting seemed to help me calm down for a while.’
‘What was going on in your life at that time?’ I probed.
‘I suppose the biggest thing was that mum and dad split up. It was horrible. One minute dad was there in the house and the next minute he’d gone and mum was distraught. I felt I needed to support her. She was just crying all the time.’
‘And what’s the situation now Katie?’
‘Mum’s calmed down. In fact she’s got a new partner, but my life’s in ruins. Mum went on holiday recently and all the relatives kept calling or phoning to check if I was all right. They must think I’m some kind of mentalist. I bet they’re planning to put me in a mental hospital or something!’
An explanation rather than diagnosis
It seemed to me that Katie had been completely emotionally hijacked.
What had started with high anxiety due to mum and dad splitting up had soon evolved into depression, as her sleep became disturbed due to chronic worrying. Her energy levels subsequently dropped and she stopped doing many of the things she used to enjoy.
The trouble is when you go and see a GP, he or she will tend to look at your symptoms through ‘the lens’ of the medical model. They may refer to DSM V, the diagnostic and statistical manual GPs and psychiatrists use, to connect presenting symptoms to a mental health ‘label’ from which a recommendation is made on the appropriate course of action and/or medication.
Fusion® on the other hand, is a recovery and resilience model and looks for an explanation for what has happened rather than a diagnosis which really seems to be a most responsible starting point. Even doctors suggest that ‘when you hear hooves coming up behind you, it is more likely to be a horses rather than zebras’. In other words, look at the most probable explanation first.
This is how I helped Katie using the Fusion® model, the Fusion® system, the tool box and the manual.
Fusion®: The model
The underlying principle of the Fusion® model is that our emotions and behaviours are always trying to help us. Depression and anxiety are viewed as messages from the emotional brain trying to prompt you to take action to get your needs met.
It looked to me like, after mum and dad split up, 15-year-old Katie’s anxiety went through the roof. She began to worry. This affected her sleep which crashed her energy and serotonin levels, so that she began to withdraw from activities she usually enjoyed.
Perhaps prompted by peers or something in the media, she decided to try self harm as a way of controlling her distress and anxiety. This can work for a while as it releases endorphins into the bloodstream, but is obviously not the most helpful strategy for dealing with stress and can also become addictive, so that when you want to stop, you simply cannot. It starts out as a way of taking control, but soon begins to control you.
Looking through the ‘SAFE SPACE’ lens, it was clear that, at that time, Katie’s life had gone from the ‘okay’ zone to ‘not okay’ pretty quickly and now her needs for safety, attention, control, family and engagement with life really were not being met at all.
Fusion®: The system
I taught Katie how to mindfully step back from anxiety by using counting and breathing to re-engage her rational brain. I showed her how to respond mindfully rather than react mindlessly to distress.
I explained to Katie that we can all be a bit bipolar when we get emotionally hijacked. Our fight or flight system, sensing danger, will send us straight into a polarised, black or white way of thinking that will convince us our whole life is a mess and nothing will ever go right in the future.
The fact is, the more emotional we become, the more stupid we become, as the emotional brain climbs into the driver’s seat of our mind and switches of the rational thinking of the neo cortex. Katie had to learn how to use the STOP System ™ to stop the hijacks and take back control.
Fusion®: The toolbox
I suggested that Katie control her yo-yoing moods by practising mindful breathing for 10 minutes twice a day to lower her anxiety. To raise levels of her feel-good hormones, she should get outside every day for at least 20 minutes, to enjoy the benefits of full-spectrum light, fresh air and exercise.
Amongst other helpful interventions, we also played the ‘let’s spot your thinking error’ game, as it looked to me as though Katie had become a bit of a catastrophiser.
Fusion®: The manual.
Everything I told Katie was backed up with clear and concise written explanations from the Fusion® manual that she could take home, read and use. Using the coaching wheel of life, we looked at her life holistically, set goals and brought together ‘a toolbox’ of mind management skills that she could draw on, to build the emotional resilience that would act like a kind of ‘psychological inoculation’ against future mental health problems.
I gave Katie the client progress log from the manual and asked her to record all the improvements she noticed as the result of our work together.
Knowledge truly is power, particularly when it comes to mental health.
The combination of a better understanding of how the brain works together with sensible and practical exercises, tasks and tools worked their magic.
After just one session, Katie began to calm down and her mood swings levelled out. Not surprisingly, her sleep, memory and concentration all improved too, and by the time she went for her assessment, she was found to within the normal emotional range with no evidence of bipolar disorder.
My young client had reclaimed her confidence in her mental health and reconnected with a vision of a bright future that would begin with university and see her move into a career in medicine.
How different it all might have been.