Where are the therapists?

I was told that because it can take months to a place for therapy I should get a place in several waiting lists. But I couldn’t get a place in any waiting lists. All the waiting lists were closed.

It’s so hard to find a therapist. They are only available to answer the phone at certain times and you always get answering machines telling you ‘if you’re calling about a therapy place, I’m sorry to inform you that I have no free places and the waiting list is closed’. It’s so demotivating to keep calling and keep being told that there’s no room for you. When you have depression the last thing you want to do is to make more calls and get rejected again. For long periods of time I would give up and not bother calling. It was January when my doctor gave me a list of therapists and until yesterday I couldn’t even get on a waiting list. If you have public health insurance in Germany it’s so difficult to find a therapist. There are so many people needing therapists and so few public therapists. If I still had private insurance that would be a completely different story (in fact I had been lined up with a private therapist last year until my insurance fell through).

When I got the therapist list off my psychiatrist, my initial plan was to seek out a therapist with good reviews. I went through the list crossing off any therapists which were difficult to get to and male therapists (I thought I would feel more comfortable with a woman) and I narrowed the remaining list down to therapists with good reviews. I was told that because it can take months to a place for therapy I should get a place in several waiting lists. But I couldn’t get a place in any waiting lists. All the waiting lists were closed.

One therapist I sent an email to told me that unfortunately she had no places available and she gave up with her waiting list because it grew very long, very quickly. But she encouraged me to keep calling therapists and keep trying because places would open up. Every therapist had the same story ‘no places, no waiting list’. It seemed so unfair to me, I was just supposed to keep calling and hopefully get lucky? At the end of the list was an organisation which was supposed to help with finding a place. I tried calling them as well but they simply told me that there were no places.

My depression has kind of relapsed recently (I say ‘kind of’, because it never really left), I’ve been getting upset about the most ridiculous, arbitrary things. Last week I had a breakdown because I entered the time for my physio appointment into my calendar wrong and ended up being fifteen minutes late. I was absolutely devastated that I could only have a ten minute appointment. Then there was the breakdown the week before after I bought a new pair of glasses and then later found out that I had bought a very expensive pair and could have saved a lot of money (it was my first pair of glasses and so I didn’t know what a normal pair costs). To top it off, my computer decided to breakdown on the weekend, and when you take online German lessons that’s really not great. (At the moment I’m using my very old, slow, clunky laptop which at any minute is going to overheat and turn itself off and has an English keyboard, which I haven’t used in years -I can actually change it to a German keyboard but then an important key is missing.)

After crying on Sunday for about four hours over something stupid and knowing that I was in a really bad state, I decided it was time to do something to change the downward spiral. I contacted my friends. I asked them to pray for me. It was also time for me to try and find a therapist again (it had been a week or two since I’d last tried to make enquiries).

I sat down yesterday with the list of therapists and decided to call every therapist in my city from top to bottom. I had a pen in my hand and if they said their contact hours, I would write that down. I would call them again, even if their answering machine would tell me they had no places. I would take breaks after every couple of calls but I would keep making more calls.

(It’s actually strange how determined I was. Normally when I’m depressed I have no determination what so ever. I’ve been especially unmotivated to do anything lately; my household chores have been extremely neglected as of late, I haven’t spent as much time learning German as I normally would, and I haven’t had much interest in leaving the house. But yesterday I managed to achieve a lot, even if it was very slowly thanks to psycho-motor retardation.)

With each phone call I got the same response ‘Hi, this is the practice of …. Unfortunately I can’t answer the phone during therapy hours, you can reach me on… at…. If you’re calling about a therapy place, I’m sorry to inform you that I have no free places and the waiting list is closed…’. I reached the seventh therapist in my city on the list. I had made some notes about her; she had a perfect rating on the infamous German doctor rating website and she had no free places. It was 12.30pm. Her answering machine picked up. ‘Hi, this is the practice of …. Unfortunately I can’t answer the phone during therapy hours, you can reach me on Mondays between 13.30-14.15…’. Strange, she didn’t say anything about not having a place. I set an alarm to call back at 1.30pm.

In the meantime I complained to one of my friends over WhatsApp about how difficult it is. ‘Germany needs a better system for getting therapy. I can’t find a place because there are none and I can’t get on a waiting list because there are none and when I called the organisation which is supposed to help me find a place they couldn’t help me’. Then we prayed together.

I called the therapist again at 1.30 but the line was engaged. I decided I would keep calling until I got through.

1.32pm: engaged

1.34pm: engaged

1.39pm: engaged

1.42pm: engaged

1.45pm: engaged

At 1.48pm she picked up.

‘Hi… I’m looking for a therapy place.’

‘Yes, that’s difficult. How flexible are you?’

‘I’m very flexible, I’m a freelancer.’

‘Ok, could you come in last minute tomorrow at 8am?’

‘Yes, that works for me.’

‘Just so you are aware, this is only a preliminary talk so we can get to know each other. This isn’t therapy. I probably won’t have a therapy place for six to eight weeks.’

‘Yes, I’m aware of that.’

‘Ok, then see you tomorrow.’

So today I met with the therapist just so we could get to know each other… not for therapy. I nearly had a panic attack on the bus on the way when my phone decided to throw a temper tantrum and Google Maps stopped working so I didn’t know how to get to the appointment (I had a vague idea where the street was, but I couldn’t just wander in the vague direction and hope to magically arrive and I’m terrible at following directions, so even if I called the therapist and asked for directions, who know’s if I would arrive). Luckily it started working well enough that I could at least SEE the map, even if it wasn’t giving directions. I probably need a new phone though.

So I arrived for my appointment with three minutes to spare. She told me to hang up my coat and take a seat, offered me a drink and took my insurance card. All the usual things. Of course, she then reminded me that this was not therapy yet and she couldn’t say when a place would open up.

‘Are you nervous?’

‘No’

‘Have you had therapy before?’

‘No… actually yes, when I was in care…’ (the phrase ‘in care’ makes more sense in German).

‘Were you an inpatient?’

‘Yes, I was an inpatient for seven weeks. And a part time inpatient for thirteen weeks.’

‘In a day clinic?’

‘Yes.’

‘How old are you?’

’24’

‘And what has happened in your life that has made you so unwell?’

I started to tell her everything: being told I was a bad teacher, failing my placements, having three of my classes ask for a new teacher in the space of a month, being afraid of losing my job… (I’ve only been wearing glasses since Wednesday but I’ve already learnt that crying and glasses don’t match. I took off my glasses, placed them on the coffee table and reached for the tissues.)

It continued for 45 minutes. She asked about my family, my relationship to my family, if depression runs in my family (yes). She would respond to my story and say ‘poh’ (which the occupational therapist in the day clinic used to say too), as if to say ‘wow, that’s heavy’. A couple of times times the therapist told me she needed a second to take in what I’d said and that my story was a very sad one. She told me I was strong and I was a fighter.

‘I’d be lying if I said you were an easy case’, she told me, ‘you’re not, but I think you know that.’

‘Yep’

‘I want to help you. I’m taking time off next week for the Easter break. I can see you in a fortnight on Wednesday at 8am. Are most of your classes in the evening?’

‘Yes, most of my classes are in the evening, sometimes I have morning classes, but most are in the evening. I have no classes on Wednesday mornings at the moment.’

‘Ok, then Wednesday at 8am or do you prefer Friday at 8am?’

‘I’d prefer Friday…’

‘Ok, then I’ll see you on April 21st at 8am.’

And that’s how in the space of 24 hours I went from not being on a single waiting list, to having a preliminary appointment, to scheduling my first appointment before a space even opened up.

It’s impossible to get a therapy place in this city. But somehow I did the impossible.

Did I have an eating disorder?

For the first time I can ever remember, I believed I was beautiful and only because I had lost weight.

Every time I get changed I inspect myself in the mirror. I think a lot of us are guilty of this. Looking in the mirror has become my daily ritual. I always have a good look at my stomach. I’m not so bad as I used to be, now I try to be positive and tell myself I am beautiful, but for a while there I was a little obsessed with how much fat I had on my body.

I was a really fat kid. In particular, if you look at pictures of me as a fourth grader I was pretty round. I was unaware of my rather large size however, until it was pointed out to me by my classmates in grade five. Every day the entire male cohort of my year would laugh and ridicule me that I was ‘so fat’ and I ‘looked pregnant’. Being fat became my identity and I started to believe that I was ugly and no one liked me because I was overweight. At the age of 11, I had my first suicidal thoughts. The daily bullying was too much for me to bear.

The words which these boys told me continued to affect me for many years and still do today. In fact, until I was 18 I had real problems trusting boys my age. Often if a boy was nice to me I always thought it was a joke -that he was making fun of me behind my back. If a boy spoke to me I would be rude to him; I would push him away so he wouldn’t have the opportunity to hurt me.

Around the age of 19, we made the discovery that I have various food intolerances. Some of the foods I can’t tolerate include artificial additives such as preservatives, colours and MSG (that nasty stuff they add to Chinese food). It turns out that two of the many symptoms of my food intolerances are increased appetite and weight gain.

About a year after changing my diet, I was getting dressed for a concert and discovered the dress I was wearing was no longer tight under my arms but actually a bit loose. I had lost a lot of weight. I mean A LOT, and I hadn’t realised till now. It was also around this time that I looked in the mirror and actually liked what I saw. For the first time I can ever remember, I believed I was beautiful and only because I had lost weight.

I lost even more weight when I moved out of home. I wasn’t trying to lose weight, but my diet just naturally changed because I was now independent. This caused me to rapidly lose weight in a short time frame.

I got so much praise from my friends and the more weight I lost, the more comfortable I became in my body and the more I believed I was beautiful. However, I also became more and more obsessed with my weight and slimming down to that magical dress size and reaching a healthy BMI.

It wasn’t just the words of my former classmates but also the words of my friends which drove my obsession. Reward and punishment had taught me that I should be thinner. The words ‘have you lost weight? Congratulations’, ‘you’re so fat’, ‘wow, look at you, you’ve lost so much weight’ and ‘you look pregnant’ drove me to obsession. My self-worth and my weight became directly related.

I was so proud of myself for losing weight but started to develop a fear of putting the weight back on. This was a huge fear for me, as big as losing my job or my visa, or not having enough money to support myself.

Ironically the obsession with my weight became even worse when I was admitted to hospital. Every Wednesday during my time in hospital I was weighed. Before then I had always avoided weighing myself, but now I was forced to face the numbers every week. I started to obsess. I had to get down to 75 kg. That would give me a healthy BMI. I was so close. 4 more kilos to go and I wouldn’t bear the title of ‘overweight’ anymore.

It wasn’t to be though. My weight stopped decreasing. Two weeks in a row my weight stayed the same. When I saw my weight hadn’t changed I started to count calories. I would eat only one bread roll for breakfast instead of two I made sure I got in exercise everyday. But it wasn’t enough, my weight started to increase.

Unfortunately one of my medications had the side effect of increasing my appetite and making me put on weight. I was having trouble controlling my desires to eat and started overeating. That’s when the trouble started. The overeating made me hate myself. Really, really hate myself.

Weight loss. Weight gain. Overeating. Calorie counting. Praise for losing weight. Criticism for being fat. ‘Look at you skinny binny.’ ‘If you lose 10 more kilos you’ll look perfect.’ ‘Have you lost weight?.’ ‘You look pregnant.’ ‘You’re so fat.’ ‘Is everyone else in your family fat?’ ‘Are you expecting?’ ‘You still need to lose more weight.’ ‘You should be proud of yourself for losing so much weight.’ Anxiety. Fear. Low self-worth. 

I was terrified of gaining weight. It became my number one fear. It fed my anxiety disorder. Gaining weight would mean I wouldn’t be beautiful. It would mean I would be letting down all the friends who congratulated me on my weight. I couldn’t get fat. I couldn’t.

It was my first week in the day clinic when the psychiatrist suggested an eating disorder. I started to get worried. Did I have an eating disorder? He wanted me to keep a food diary and suggested I might need to go to another clinic for eating disorders after my time in this one. My doctor told me that my self-worth and weight were on a seesaw. If one went up the other went down. I held the believe that I was worth more skinny, people would like me more that way.

Talking about an eating disorder made me think about food even more and one night I found myself standing over the toilet bowl with my fingers down my throat. But just before I started purging I stopped myself and asked, ‘what are you doing?’.

It was that moment that I took control. I never attempted to purge again. I still have that desire to lose weight and I pray to lose weight. But in my prayer I also ask God that I would want to lose weight because I feel better when I’m healthy, not would because I fit the world’s standards.

I know I still have healing to go, but I can truly say, as I write this, I am happy with who I am and I am happy with myself. And, I am not fighting my battles alone, I have both a psychiatrist and a psychologist, I am looking after myself by taking my medication and listening to my doctors.

My two pieces of advice:

  • If you notice a friend is losing weight and wish to give them a compliment, focus on their overall appearance rather than their weight. Tell them they look beautiful or nice, or that new dress looks great on them, but avoid words like ‘skinny’, ‘slim’, ‘weight’, etc… While it’s well intended, complimenting someone on their weight loss could spark an eating disorder.
  • If you suspect you have an eating disorder or have issues with your self-worth or know someone who does, I strongly advise you to seek help from a professional. See your GP, psychiatrist, therapist or counsellor.

The road to hospital

At home I would just lie on the floor crying. I couldn’t get up, no matter what I told myself.

I could have died last year. I’d thought about killing myself so many times. Sometimes on the way to church, I would think about getting on the wrong train and heading in the opposite direction to a place where I would end it all. I remember once thinking ‘at some point I’m going to kill myself, why should I wait?’. In December I wasn’t just thinking ‘I want to kill myself’ or ‘I should kill myself’, I was thinking, ‘I’m going to kill myself. Yes, I’m going to kill myself. I’m going to kill myself. I’m going to kill myself. Yes, I’m going to kill myself. I’m going to kill myself. I’m going to kill myself…’. You probably get the picture. But seriously, this went around and around and around in my head like a broken record. By Christmas I had been fighting suicidal thoughts for months and I was at breaking point. I couldn’t go on anymore.

Anxiety was building inside of me like a large pressure cooker about to explode. I would look ok on the outside, but I would be screaming on the inside. At home I would just lie on the floor crying. I couldn’t get up, no matter what I told myself. Over and over I would tell myself to get up. Get up. Get up. You can do this. Get up. But I just couldn’t. It was like my arms and legs couldn’t hear my brain. Get up. Get up. I’d walk so slowly too. I’d tell myself to go faster. Come on you can do this. You can walk faster than this. But I just couldn’t. My legs were so heavy. They just couldn’t move. Everything was so challenging. Household chores just weren’t happening and a few times my dishes only got done because a friend would do them for me.

I hated myself, I couldn’t love myself. In fact, I couldn’t love anything or anyone. All the joy was sapped out of my life and I had such an ugly idea of myself that I couldn’t understand why anyone would want to be friends with me. People I didn’t know would come to me in church and ask if I was ok. It was obvious something was wrong. I was always crying and I was always looking down. People kept telling me to look up, but what they didn’t understand was that I couldn’t. My head was just so heavy and when I tried to look up I just felt this enormous weight. That was one of the physical effects of depression.

At this stage I had been taking medication for months. I was on a herbal anti-depressant called ‘Laif’. It was great because it had very few side effects, but it was designed for mild-moderate depression and I’d surpassed moderate depression a long time ago. I was also receiving counselling which likewise wasn’t helping. My counsellor told me my sessions weren’t going to work until I had the right medication and although my GP had referred me to a psychiatrist, the appointment wasn’t for another month.

Over Christmas, I stayed with a friend in the Black Forest. She probably couldn’t see it, but I enjoyed my time there a lot for someone with such severe depression. However, this was my breaking point. I had severe depression and anxiety, I wasn’t thinking straight and I came the closest I ever came to killing myself. Fortunately, being in the Black Forest and in an unfamiliar house meant I had fewer methods available to kill myself and so I didn’t make any attempts.

I doubt I will forget that moment when my friend, cried and made me promise not to hurt myself. She was afraid to leave me alone and the next day, on Tuesday the 29th of December, 2015 she gave me no other option and brought me into hospital. I was not happy about going to hospital, but I was unable to think for myself anymore. Neither of us spoke during the whole car trip from the black forest back to my home. I couldn’t. My brain was too busy processing a billion thoughts of why I knew I needed to go to hospital and why I didn’t want to go. My friend took me home and told me to pack my bags. I just complied. The decision wasn’t mine anymore. I was too sick to make a decision. Everything was just too hard or too scary and I am thankful that she stepped in and made the decision for me.

During my first night in the hospital I just laid in bed and cried until I fell asleep. That was quite early mind you because I was on a high dose of medication to calm me down, which also made me drowsy. I spent the next 7 weeks in hospital and a further 13 weeks in a day clinic. Hospital was absolutely the right place for me; I was put on medication which really helped me and had various therapies. Over the 20 weeks I had psychotherapy, art therapy, music therapy, occupational therapy, enjoyment classes, depression classes, role plays, social competence training, dance therapy, movement therapy, and outings. I didn’t enjoy all of my therapies, but some of them definitely helped.

I have been out of hospital now for 7 weeks and life is better. I still have off days and am still learning to deal with the side effects of my medications. But I know how to deal with my illness now and what to do if I’m upset.

If you are suicidal or know someone who is suicidal, seek help immediately. Call a suicide hotline or if a life is in danger call emergency services. Mental illnesses do not need to be fought alone. Don’t wait. Get help.