I am a survivor of familial child sexual abuse and was groomed and then raped between the ages of five and ten years old. I am now 61 years of age and in 2018 following the death of my mother I was repeatedly attacked violently by my younger brother who was a drug and gambling addict. The attacks resulted in spinal damage for which I had surgery twice early in 2020 and lots of pain medication… oxycontin, oxycodone, mogadon and tramadol.



In late 2020 I was suicidal, highly anxious and hypervigilent and was admitted to the crisis centre of GGZ inGeest. I have to say that the crisis centre was very good and they diagnosed PTSD and reactive depresssion and borderline conditions. I was immediately placed upon oxazapam and quetiapine medication which I will come onto later. I was under treatment from the crisis centre for about four to six months. Where an opportunity for you to improve starts, is when the patient moves on to further therapy. It was at that point that I wasn’t diagnosed properly due to a lack of time and lack of communication between the departments and was put straight into Dialectical Behaviour Therapy, which I was not ready for as I needed trauma therapy and the quetiapine was starting to become a problem. My personal coach during this DBT therapy was Willem Struijs and he took on the role of support therapist that the crisis centre had been providing even though he was supposed to be my DBT coach. I cannot speak highly enough of Willem Struijs and he saved my life on several occasions.



The DBT therapy was a disaster as it coincided with the covid outbreak, remote group sessions did not work as the technology was not in place and there were some personal conflicts with the group therapy sessions. Reducing staff turnover would also be an improvement. Changing therapists during a patient's therapy is a likely cause for a setback. Just like when medication is being prescribed without knowing the side effects. Let alone warning the patient about them. So, make sure the psychiatrists know all the side effects of prescribed medication. It could have prevented me from getting a severe eye infection.



Returning home after a therapy session I was exhausted most of the time and couldn’t speak to my wife and son about it for days. But they were worried and had questions, especially about how to deal with me. They reached out to GGZ inGeest for help but all they were told was that it was not possible to share information due to confidentiality. Therefore, they received no support. I would strongly recommend that GGZ inGeest provides better family support. If necessary, work around the confidentiality and provide general information if the family reaches out for help. If GGZ inGeest had only asked me, I would have agreed to share information about me. I just wasn’t able to share this information to my wife and son myself.



It’s a good thing GGZ inGeest provides group therapy in English. But it would be wise not to mix native speakers with non-native speakers. I’ve experienced that it gives the patients who are native speakers a head start, making the therapy not equal and I ended up more of an English teacher than a patient. And also try to create smaller groups. Last but not least; don’t be too hard on someone when skipping a therapy session. Be a bit more flexible on the rules, look more closely at what the patient needs.



As you can see it basically all comes down to a better awareness of when things go wrong or can go wrong. Make sure you recognize them more early. And doing so, involve the patient and his or her family more. In the end I finished the DBT therapy thanks to some personal sessions with Loes Smits who was very helpful. Also it would be useful to have a native English speaker in these sessions perhaps as a volunteer (I would be prepared to do this!)



Following the completion of the DBT therapy I attended the residential PTSS5 trauma treatment course for a week. The first three sessions dealt with the violent assaults and were very successful. The last two sessions dealt with my early (first) childhood abuse and rape and these last two sessions completely overwhelmed me, this was reflected in my CAS scores after a week. After this week I was suffering four or five bad dreams (nasty dreams) per week and my suicidal tendency returned. The follow up to the PTSS5 was poor in my case when it was obvious to everyone around me that I needed some immediate help and I was about to readmit myself to the crisis centre. However, following some consultations with Loes and Willem a strategy was formulated to provide some therapy based upon Imaginary Rescripting Therapy with Mattijs v/d Boom. This therapy is still ongoing and has been highly successful. I have had about twenty sessions and still have two sessions remaining and I cannot speak highly enough about both Mattijs and Willem during this time.



RECOMMENDATIONS

1. Psychiatrists should be aware of the most common side effects of the meds they are providing because when I was under treatment by the eye specialist, he told me that many of his patients were taking quetiapine or similar medication.
2. Communication between the various departments is poor, the crisis centre, the DBT group, the personal coach, the PTSS5 treatment group and the rest of GGZinGeest need to communicate better and act of those communications before problems become crises.
3. The English DBT group needs to improve its technology for remote attendees and they need to be aware of the difference between those attendees where English is not there first language and those where it is.
4. Staff turnover is an issue… many patients strike up a personal relationship with their therapists and suffer setbacks when their therapists move onto another position.
5. Prioritize trauma therapy where required.



- Michael, fermentation and food scientist, PhD in microbial biochemistry