kaberett: Clyde the tortoise from Elementary, crawling across a map, with a red tape cross on his back. (elementary-emergency-clyde)
I have been meaning to write this up for a while and have just had cause to do so elsenet; ergo, have a copy of Alex's Algorithm For Choosing A New GP. It has served me pretty well thus far.

Comments and additions welcome, as ever. :-)

Read more... )
kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)
(Motivated by the fact I've had this conversation with several people in the last few months.)

That's a slight overstatement, but honestly not much of one: periods shouldn't hurt so much that they impair your normal function. The idea that "everyone gets cramps", or that you're making it up, or simply not tough enough, is toxic nonsense.

Endometriosis is reckoned to affect approximately 10-15% of people who menstruate. It's pretty much the most common cause for painful periods, it's way under-diagnosed, and last I checked the diagnostic delay in the UK (between when you first tell a healthcare provider about symptoms and when you actually get the diagnosis) is about ten years.

So: hurting so much it impairs your function is really not normal. Under the cut is a discussion of a bunch of other stuff that isn't normal and might be indicative of endometriosis, and some suggestions about how to approach medical professionals on the topic.

Read more... )

Here, for reference, are the NICE recommendations relating to endometriosis.
kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)
The proximate impetus to write this is that I'm trying to get back into the swing of technical, information-dense long-form writing. The motivation with respect to content, however, is that there's a whole lot of information about all this stuff and I found it utterly overwhelming when I was first seriously looking at mobility aids, especially in a cultural context that is hellbent on insisting that it's far more important that we look "normal" than that we be comfortable or capable. Form over function, as applied to people, is something that makes me particularly cross. Ergo.

The focus of this guide is manual wheelchairs for everyday active independent use by people who can stand and walk to some extent.


  • Orientation

    • Price points
    • There are lots of correct choices

  • Decisions

    • Materials
    • Frame
    • Footplates
    • Wheels
    • Seating
    • Additional features

  • Process

    • Measurements
    • Acquisition

  • Recommendations

    • Accessories
    • Aspirational

  • End notes

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kaberett: A drawing of a black woman holding her right hand, minus a ring finger, in front of her face. "Oh, that. I cut it  off." (molly - cut it off)
(Turns out I have at least some friends who haven't heard this particular rant of mine before, and I can't face wading through tags to see if I've had it properly already, so! Here we are. Content notes for everything you'd expect in terms of abuse, medical neglect, medical incompetence, terminal illness, etc.)

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kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)
(Cis friends, by all means ask me questions to clarify, but maybe consider sitting out of actually having an opinion in comments on this one. Anon comments are permitted but will be screened; I expect to unscreen unless otherwise requested.)

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kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)
So this is actually a pretty short one: all you should need to do is say one of "that's not the problem" or "I don't want to talk about it" and the counsellor should back the fuck off.

I have had counsellors back off and never raise the topic again when I asserted that something wasn't the problem even when it blatantly was, because the way it goes if you say one of those things is this: either you are right, in which case you are right, or you are wrong, but clearly not ready to talk about it yet, and the best thing for everyone would be to leave you to your own devices while you come to terms with that, and focus on the other shit you're actually in a place to work on.

It is my view that if your counsellor is any good, they will recognise this.

Which is all very well if you are me, and have got lucky with (1) counsellors you've been assigned and (2) the ability to actually make choices or swap as seems appropriate.

Unfortunately, the above is fundamentally a "no", and if you've got a counsellor who ignores your "no" then you've got a counsellor who ignores your boundaries and that is Not Great, especially given the extent to which therapeutic relationships (can) require you to be vulnerable.

If you're stuck with a counsellor who insists on pathologising something that you'd rather they left well alone, some possible scripts are:
  • Actually, this week I really feel the need to talk through [Thing On Your List].
  • [if it's something like poly] I'm aware that this is a little unusual and you may not have come across it before. If you'd like me to suggest some background reading for you, I'm happy to do so, but I don't want the focus to be on [thing], and I'm finding treating it as inherently bad really offputting - it's making it more difficult for me to address my main concerns.
  • I understand your concern, but I don't feel like this is something I'll benefit from working through in this space at the moment - I feel like I've got more work to do by myself before I'm ready to talk about it out loud. [Thanks for making it clear you're willing to engage;] I'll let you know when I'm ready to tackle this.

And so on - the sort of not-quite-lie that firmly redirects.

But, as I say, these scripts are what I like to think I'd use; I've never been in a situation I couldn't solve by Stopping Seeing That Counsellor And Finding Someone Else Instead (and, again, I'm aware of how lucky I am that that was an option for me). So for those of you who've had to deal with this, I would super-appreciate your experiences in comments. <3
kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)
In the approximate chronology of this series of posts, we have now had our first session with a new counsellor, and we are thinking about how to plan for the next one.

A habit I'm attempting to get into is writing up notes from counselling immediately after the session happens (which I then post to DW, because that's the easiest way for me to manage and think through these things): this helps me keep track of the patterns and metaphors I've been discovering, and means I can't forget useful things. Write-ups are based on very brief notes I make during the counselling session.

Over the days before my next session, I start Making A List. Usually longhand in one of the notebooks I carry around, because that's what works for me, but occasionally in a text file I sync between computers. I start out by reviewing the previous session's notes, and from there build it up a bit like this:
  • have I taken any actions planned last session?
  • have there been any developments with respect to situations/interactions discussed last session?
  • has anything major happened since last session?
    • Shit I Found Difficult
    • Shit That Is Complicated
    • Shit I Don't Know How To Feel About
    • Shit I Am Proud Of

  • have I been keying particularly hard off any music/poetry this week? How's it been making me feel?
  • have I read anything (particularly relating to How Brains Work) that I'm trying to fit into my working model of myself?

Back at the beginning of March, this was my list:
- Still Catch The Tide
- making a really bad yardstick in general - does this apply to counselling too?
- culture of mental illness among PhD students vs my lived experience
- negotiating care needs
- cleansing ritual!
-- seeds continue to germinate :-)
- craving interaction

... and obviously that's a lot of shorthand: but it's enough, in each case, to be a prompt for the tangle of attached thoughts, cf the way that "negotiating care needs" did indeed turn into an essay.

I've yet to start working on the next list - I seem to be antsy about doing it when I don't have a definite date in mind, though we're coalescing on the 4th of April - but for me the absolutely key thing is to give myself time to work on it, so things can pop up and get written down and not just vanish again.

I think I haven't made this explicit before, but I'd love to know how your strategies, if you have them, differ :-)

(Next: setting boundaries with counsellors.)
kaberett: a watercolour painting of an oak leaf floating on calm water (leaf-on-water)
I semi-regularly end up trying to infodump my (theoretical) approach to a first session with a new counsellor; I've been asked about this often enough that I'm going to try to make a summary here. (I say "theoretical" because in practice what actually happens is I forget everything I advise other people to do and mostly panic: I can easier teach twenty what were good to be done than be one of twenty to follow mine own teaching.)

From my perspective, the point of a first session is to establish whether I think I can work with the counsellor in question.

Read more... )

And so in summary, my checklist going into a first session is:
  • what's the edited-highlights-of-my-life I want to give this person?
  • am I comfortable with the ways they respond to them?
  • do they have minimum required knowledge such that I won't be spending so much time educating them that they should be paying me?
  • are they pathologising or fixating on things I don't want the focus to be on?
  • do I think I can be I comfortable in their space?
  • are we communicating adequately well, bearing in mind that we'll build on it?
  • is there enough flexibility in communication methods for me to cope?
  • am I responding well to the ways they choose to guide our discussion? Do they feel useful?

... all of which I expect to need to sit with and work out over the days following the session, but are roughly what I try to bear in mind going in, and are what I focus reflection on after the fact.

Next up: a slightly more formalised version of how I plan for sessions than the demonstration (under access lock, tag "counselling log") a few weeks back.
kaberett: a watercolour painting of an oak leaf floating on calm water (leaf-on-water)
Previous interludes are under access-lock. As stated elsewhere, in general I grant access very readily, am happy to receive requests regarding same, and use lock so I know to first order who is reading. That's why the numbering looks out-of-order. Additional disclaimer: I have drugged myself to hell and back again and it's all kicking in over the course of writing this post, so like, if it stops making sense halfway through then (1) I apologise and (2) I'll be back in the morning to fix things.

<edit>now more sober, I realise that it would be helpful to state explicitly that I am here talking about finding a private counsellor, which obviously involves a significant amount of financial privilege, even with low-income places. I discuss my reasons for using private counselling in comments.</edit>

There's a number of places I look when I'm trying to find a counsellor. They include:
This shortlist arises at least in part because I know what I am looking for. I know that I do my best brain-work when I'm teasing out why I think/feel/believe/do A Thing: the way I approach the world, I find it much easier to address a problem when I know why it is happening. That's why ACAT's on the list above: Cognitive Analytic Therapy is the framework most of my counselling's been in; it combines aspects of Cognitive Behavioural Therapy (e.g. techniques to challenge intrusive thoughts) with a narrative approach (i.e. working out why). (The ways in which CAT works really well for me are... abundantly clear, I think, from my habit of exploring my emotional state and wellbeing and relationship to the world via contextualisation/resonance of song lyrics and poetry.)

BACP is on the list because they've accredited every counsellor I've ever worked with and, for that matter, every counsellor I've ever considered working with. They're more-or-less a gold standard.

And PinkTherapy is included because I'm poly, trans and queer, and I really don't want to have to explain that from scratch to someone I'm paying private rates.

So my process for finding a counsellor goes a bit like this:
  1. Work out what style of counselling I probably want (in addition to CAT, I'm currently doing a lot of self-led Mindfulness-Based Cognitive Therapy, and I'm getting on really well with it).
  2. Find directories of counsellors relevant to my broad geographic region (country-level).
  3. Filter to local (or willing-to-Skype).
  4. Filter to types of counselling I'm interested in.
  5. Run through the list and see if the individual profiles suggest that the person in question has sufficient relevant experience that I won't want to scream before we're ten minutes in to a first session (for me, that means "has heard of queers" and "has worked with trauma"; "knows what an autism is" is a bonus; "will do Skype counselling and is flexible about session regularity" is SUPER-AWESOME but I don't expect to find it).
  6. No luck? Remove one of the constraints (starting with style-of-counselling - though I note that I have some pretty hard limits about the level of fluff I am willing to tolerate; I fundamentally want counsellors I can trust to tell me I'm talking bullshit, if necessary, in those words).
  7. Sit with the shortlist for a few days and see who sticks (much like my approach to purchasing Lioness jewelry, entertainingly enough).
  8. Start sending out e-mails (ideally one at a time) to enquire as to (i) space on their list? (ii) willingness to set up a first session?

And then, of course, there's the issue of the actual first session. How I tend to approach those - and the suggestions I'd make to someone going into a first session, especially if they've not had counselling before - comes in the next Interlude.
kaberett: a patch of sunlight on the carpet, shaped like a slightly wonky heart (light hearted)
If I offer to accompany you to an appointment, or to act as a medical advocate for you, what I am offering is anything you like from the menu below, plus probably some other stuff I haven't thought of. I am not trained; I've just spent a lot of time around the NHS and private healthcare, one way or another. As far as I'm concerned, these are some of the things that medical advocacy can look like - and wanting one doesn't mean you want any of the others.
Read more... )
This list probably isn't exhaustive, but everything on it is included in any offer I make to act as a medical advocate for you. Obviously negotiation is needed - and more negotiation is needed the more involved you want me to be. For example, if you want me to speak on your behalf that is fine, but I will need an extremely thorough briefing on what to say, and will want to negotiate ways to check in with you in advance. If you want me to monitor you for signs of distress, I'll need to know your "tells" (for me, one is that I start rubbing my throat when I'm getting stressed).

I'd be very, very interested to hear from people about what steps I'm missing, because inevitably there'll be some ;) And also how this matches up with your concept of medical advocacy, if you had one, and so on and so forth!
kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (swiss army gender)
As ever, this goes for me only. Do not assume that anyone else does - or should - take the same attitude as I do at this stage in my life. [I note also that this is not intended for people who are misgendering me maliciously (hint: not okay).]

And with that out of the way, let's move on to the body of the post. )


kaberett: Trans symbol with Swiss Army knife tools at other positions around the central circle. (Default)

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