Back in June 2018 I was in full time employment but spending a couple of hours a week in group therapy at the Complex Needs Service in Oxford. I had no official diagnosis because I decided, on the advice of a Doctor, to keep any specific mental health diagnosis off my medical record, firstly because of the stigma around mental health problems but also because it felt wise to wait until I’d got further into my therapy, in order to make a more healthy decision. At that point I felt fairly certain that my main diagnosis would be for Borderline Personality Disorder (alternatively known as Emotionally Unstable Personality Disorder), I had completed the relevant questionnaire (DSM 5) at least twice and examined the main traits of BPD, I felt I had all of them to a problematic degree.
In about 2016, I finally managed to be referred to an appropriate local mental health service and began a few years of mostly very intensive therapy. I did Mentalisation Based Therapy, Emotional Skills Group therapy, focusing on emotions, unhealthy thinking habits, grounding techniques. Then in 2018, I was accepted into a Therapeutic Community for 15 hours a week, along with up to 17 other people with personality disorder traits, trauma and various serious problems. There were several therapists in the group, plus a psychiatrist but this was not a traditional clinical setting. There were very clear boundaries in how the group worked, disclosure had to be kept within the group. Jobs such as cooking and shopping, were shared and rotated. There were weekly psychological education slots, where we would learn about things like Transactional Analysis, communication styles. Drama triangles and so forth. Largely though, it was about relationships, with others and ourselves. It involved understanding my unhealthy defences, stripping them away, being challenged by everyone, exposed to my vulnerability, for 18 months.
I had done 10 weeks of Mentalisation Based Therapy (MBT) and was about 10 months into the Emotional Skills Group (ESG). One of the possible places to go on to after ESG, is what is known as a Therapeutic Community (TC). The TC takes place in the same building as ESG and 2 members of the TC take part in the ESG group each week but as co-facilitators (along with staff members such as the therapists and a psychiatrist), so I was familiar with the concepts of the TC and some of its members. I had gained a lot from being in group therapy but I realised that my journey wasn’t over, actually in many ways, it had just begun. So I decided I would apply to join the Therapeutic Community. I knew joining the TC would be a big commitment, it’d be hard work but despite the preparation beforehand, I wasn’t prepared for just how hard it would be. I thought I might even be able to continue working part time whilst putting in 15 hours a week in an NHS mental health facility along with up 17 other people with personality disorders, who had suffered trauma. Part of me felt ashamed of the idea of not working but letting go of that later, proved to be a useful relief, to be able to get on with fixing myself without the anxiety around work. Initially I also thought I could get away with only doing 10 – 12 months in the TC instead of the full 18 months, partly because I knew that after 12 months, my employer would cease to pay me, I’d have no income and I’d be living off my savings, that idea also fell by the wayside quickly. I had timed things very accurately and close to time limits, done my afternoon and full week visits to the TC so that I would be in the best place to make up my mind. So I applied to do the “Joining Case Conference” for the Therapeutic Community
My ‘joining case conference’
My case conference was on a Tuesday morning at 9.30 am, about a week after I had booked it whilst still in the Emotional Skills Group. I was met in the foyer of the building by 2 TC ‘members’ who were acting as hosts that day and was welcomed into the building which I was already somewhat familiar with anyway. After hanging out in the kitchen and garden for a while with the TC members, we all went into the main large group room for the Opening Meeting at 9.15 am. All the TC members (including 3 therapists, a psychiatrist and 1 or 2 students) sat as usual in a big circle of chairs. There was 15 minutes of TC business, which as usual only TC members could speak in and then came my time.
I had prepared some text about myself, based on guidelines from the TC, which I read out in the allotted 10 minutes. There was a little bit about my history and problems at that time and I’d already got used to the idea that there’s not enough time to cover everything. I wasn’t on any medication so nothing to talk about there. I spoke about what I thought I could bring to the community and what I thought I might find challenging about being a member of the TC. I felt reasonably confident because I had been a reliable member of ESG, I was prepared to commit the time required of me.