I went out with all the best intentions on my visits last week. I was going to see a couple of people I hadn’t seen for a while but about whom I wasn’t overly concerned, to discuss the end of my involvement with a view to working towards discharging them both from CPA (Care Programme Approach).
One woman, I’d been working with for just over a year. She has an anxiety disorder but due to changing external circumstances has been managing her day to day life much more capably. She has, since I first became involved, moved into sheltered accommodation and has re-established contact with a previously estranged family member with whom she had not had contact for about 10 years – and whose detachment from her had been a source of great sorrow. Both of these factors had significantly improved her quality of life.
I discussed with her the possibility of discharge. She became angry, upset and yes, anxious. Sometimes the discharge comes as a relief but in this situation I think she may have interpreted it as a punishment. However many times you explain at the first meeting that the work can be time-limited, it is often a surprise when discharge is discussed.
Perhaps it was a bad day but I left the thought with her. I imagine it will be a slower process than I had expected but I think I can do some kind of graded reduction of visits and more discussion of endings and ending as a positive (which, of course, it is).
The other person I saw, someone that I first visited in December, is a deeply devout woman who has made an astonishing amount of progress in that time. I was allocated to her because I was one of the few people at work in the days between Christmas and the New Year and our consultant was insistent that she be visited in this period due to the high levels of concern about her.
Justifiable high levels of concern as my first visit to her involved me spending about two and a half hours trying to convince her to come to hospital informally we were that very worried about her. She didn’t come and in retrospect, I’m glad she didn’t although there was a very shaky period at the beginning of the year.
I spent a lot of time with her in those first few months but as time went by, she began to re-establish links with friends and family and social circles – so from finding it difficult to be in the house on her own, she returned from a foreign holiday last week. Almost a miracle – if I believed in those kinds of things.. in fact, it is a testament to the resilience of the human condition.
I had felt that my much more sporadic visits were not a significant factor however when I discussed with her the idea of closing our contact – she explained that she wasn’t quite there yet.
Still a little way to go then. I don’t like goodbyes – I find it one of the harder aspects of the work except when people are so glad not to see you anymore – and it is rarely that they can be achieved quickly. The difficulty is, of course, that the work keeps coming in so something has to give..