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Goodbye Letters

Michelle Hamill and “Rosie”, 2016. Goodbye Letters. Reformulation, Summer, pp.19-21.

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Dear Editors at Reformulation,

Following discussion with my psychologist, Dr Michelle Hamill, I would like to offer our goodbye letter for your consideration for publication, as a personal account of how beneficial CAT has been for me in addressing my anxiety and low self-esteem, which I had experienced since childhood, and that regardless of age, it is never too late to change and feel better about yourself. 
Yours Sincerely, 

Rosie (aged 68) 

Dear Editors at Reformulation,

I enclose the goodbye letters from Rosie’s CAT. Rosie was referred to our service due to severe depression, which necessitated a brief admission. Rosie was experiencing insomnia, anxiety and loss of appetite. On clinical measures her scores were in the moderate- severe ranges for mood disturbance. Rosie engaged in 16 sessions of therapy, followed by a three month follow up, and then six maintenance sessions due to a brief relapse. Her scores on clinical measures are now in the non-clinical ranges once again. 

Rosie is keen for her therapy experience to be shared given how positive she found the CAT process in her recovery. We thought that submitting our goodbye letters would give the readership an overview of the experience. 

Yours Sincerely, 
Dr Michelle Hamill 

Dear Rosie, 

We have come to the end of your therapy. I feel we have been on quite a journey together. I want to thank you for taking the opportunity to work with me over the last five months. Your courage, resilience and commitment have been inspiring and it has been an absolute pleasure and joy to work with you. This letter is my reflection of the achievements you have made; becoming free from past restraints and unhelpful habits that had kept you feeling worthless, undeserving, and anxious for so long. 

Our focus in therapy has been to make sense of your feelings of anxiety and depression within the context of your life so that you could learn to manage stress and the expectations you placed on yourself differently. You were struck by the idea of having unhelpful habitual patterns related to long held beliefs, feelings, and behaviours, which could be identified and changed for the better. However, when it came to improving your self-esteem, you did not think it possible that you could ever feel confident in yourself. What a triumph this has been! 

To make sense of your lifelong struggles with anxiety and low self-esteem we looked back over your life. You acknowledged a range of unhelpful patterns from your early life including pleasing others and putting other’s needs ahead of your own; your own needs being disallowed and forbidden. Your early life was replete with experiences of loss, loneliness, criticism, and punishment, and feeling like you could never do the right thing, resulting in chronic low self-esteem and a lack of confidence. You learnt that it was not acceptable for you to show any emotions or express any needs or wants or you would be punished. So to keep yourself safe as a little girl you learnt to keep quiet and keep yourself to yourself. However, this also left you feeling desperately lonely and isolated. We discussed how these patterns have affected how you managed stress as an adult, whereby putting too much pressure on yourself and feeling unable to cope (for example worrying about Les’ health) triggered memories of being vulnerable as a little girl, leaving you once again feeling powerless, anxious and helpless, resulting in a downward spiral into depression and insomnia. 

However, by recognising these patterns as they recurred in your daily life you have been able to question their usefulness and start doing things differently. The two main patterns that we have worked on were your tendency to be ‘criticising/ blaming to yourself leaving you feeling criticised/ blamed’ and ‘rejecting/ dismissing to feeling ‘rejected and dismissed’. These patterns were also evident in our relationship, where initially you were quick to dismiss and criticise your efforts, starting each session by saying that you hadn’t done much that week. Now, instead of berating yourself and thinking you won’t be able to cope with life’s stressors you are learning to be kinder, more supportive and compassionate to yourself. You have worked so hard to find a more balanced approach to life and attend to your own needs, freed up from the weight of guilt previously associated with considering what is it you want and would like in life. Now you can see that your needs and wishes are just as important as everyone else’s. 

You have made so many changes over the last few months; driving, going out on your own and engaging with other people, challenging your belief that other people won’t want to talk to you or that you don’t have anything interesting to say. You report a new found sense of confidence in yourself and joy in life. It is important to acknowledge your independence in your recovery in getting out and about; that you did it yourself without relying on your partner to go out with you. It has been wonderful to share this joy with you, seeing you revel in excitement for life. 

You have been making excellent progress using your diagram to notice when the old habits are trying to pull you down and instead practise being kind to yourself. I was so moved by how you handled being flooded by critical, dismissive, hostile thoughts that you ‘weren’t allowed’ to rest or ‘feel sorry for yourself’ and that you ‘weren’t allowed to cry’ when unwell and exhausted from your persistent cough a couple of months ago. Instead of getting caught up in your old patterns, you found it in yourself to challenge them and respond to your aunt’s ‘voice’ by insisting you were allowed to rest and look after yourself. Later you were able to hold onto a sense of pride and achievement at how you didn’t slip back into a spiral of self-criticism and depression. More recently you allowed yourself to rest when unwell, without any guilt, attending to your needs with care and compassion. 

You are also no longer plagued by worries about things (such as your recent chest x-ray and our partner’s diabetes diagnosis), rather telling yourself you will deal with things as arise should you need to, showing a new found sense of inner security and trust in your capacity to cope in life. This has given you the ability to enjoy life in the moment for what it is. Writing down your daily achievements has provided you with a permanent record of the changes you have made. Comparing your letter from Dr Smith in April prior to your admission to Ivory ward, where we first met, to that of Dr Brown’s recent letter showed just how far you have come. You described therapy like ‘putting on a new pair of glasses’ and that now you can see things clearly, knowing that you do not need to listen or engage with the old habits anymore. 

Your partner has now bought his new scooter and already you have had some lovely times out on the Southbank together. You are exploring the possibility of working in a charity shop and are also continuing to look into moving to Norfolk longer term, having recently made an offer on a place. I shall miss our weekly sessions but I feel confident that you will continue to remain well, practising what you have learnt, especially being kind to yourself and recognising your achievements, no matter how small you may think they are. I look forward to seeing you for your follow up session in three months’ time. Please do not hesitate to contact me in the meantime should you need. 

Fond regards, 

Michelle 

Dear Michelle,

Firstly I really must thank you so much for the letter which you wrote to me back in May, which has been so helpful in my recovery and understanding of how and why I have had such difficulties with anxiety, depression, lack of confidence etc. As you have said to me ‘the power of the written word’. I have read your letter time and time again and have been so comforted by the way you understood how I felt as a little girl, and have helped me to understand my behaviour as an adult. I have learnt to grieve for that little girl, I now know that it’s not sulking or feeling sorry for myself but that I had needs then, to be loved most of all and yes, I did find that warmth and love in the chicken coop. It doesn’t sound silly anymore to say that, I now think I was a clever little girl, who else could say they had chicken friends to play with. 

I am moving on now into a whole new way of living, which sometimes I still find hard to believe; but am gradually learning to accept. To be able to wake each day and look forward to new experiences, new places, new people, but most of all a new confidence, which I thought I would never have. Everything seems so exciting now, even doing something like food shopping. As I said to you before it’s like putting on a pair of new glasses, I am so much happier now than I have ever been. On reflection, I do now understand the how’s and whys of CAT therapy and would recommend it highly for those who are stuck in a miserable rut, or who are forever going round in circles and getting nowhere. The therapy for me seems to have opened up lots of little boxes, in which each had a part of a puzzle, which now seem to all fit together, showing me a lovely picture, I can’t thank you enough for helping me and showing me the way to leave my old patterns of behaviour behind, namely lack of confidence due to self-criticism, anxiety, fear of being rejected and many other unhelpful habits that have been with me for so many years. Now I am moving forward, I have a more balanced outlook on life, I’ve learnt to care for myself without feeling guilty, which in turn has enabled me to care for others in a much better way- yes I’ve found the middle ground!!

I will miss coming to see you each week, but as I have told you I can hear you so often with your kind and encouraging words, helping me along life’s journey. I am going to set aside time each week to try to study mindfulness; I really feel this will be helpful to me on my journey of understanding and caring for myself. 

I will look forward to seeing you again in a few months’ time, and hope when we meet again you will be very proud of our work together. I won’t let you down. 

With fondest regards
Rosie X

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Full Reference

Michelle Hamill and “Rosie”, 2016. Goodbye Letters. Reformulation, Summer, pp.19-21.

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