Have We Taken One Small Step Forwards?

I am cautiously impressed with Julie's new psychiatrist, Dr Clyde. Cautious, you understand, because we have had a lot of false hopes in the past, and in any case she only sees him occasionally. But there are a lot of things I like about him.

1. He is fairly accessible: he only works a few days a week at the clinic but he will try to ring you back if you leave a message at other times. He saw Julie at very short notice last week, having recognized that she needed extra help.

2. He is not at all afraid to use the phone: he has spoken to Julie himself a couple of times when there were problems, and he encourages other staff to ring her rather than demand that she is hauled into the clinic. This alone has vastly improved our support levels, since he has arranged for staff to ring her at home regularly during difficult patches.

3. He does not treat her parents as something that should be left at the door on her way in: he saw her last week with her dad in the same room. With other staff we normally sit in the waiting room and are lucky to get a few hurried instructions at the end of a session.

4. He seems willing to work with her parents as equals. He phones me up as a matter of course, he seems to expect that we should have some insight into our daughter's needs, he asks our opinions about possible treatment, and when he circulates the minutes of a meeting, he asks if we want to comment or correct anything.

5. He favours common-sense solutions. If Julie is short on sleep, he recommends sleep. If she is panicking about attending school, he suggests cutting down on some of school, but keeping the contact going.

6. At the same time, he is not afraid to talk theory with Julie. She is a bright kid - he recognizes that and he doesn't hesitate to bring abstract ideas into the conversation if he thinks she might find them helpful. In the meeting the other day he spent time explaining to her why stress might make it even harder for her to concentrate, which in turn increases her stress levels.

It is difficult to be certain that any of this matters, but what is certain is that with Dr Clyde's support we have pulled back from the brink this week. Instead of the initial self-harm incident leading inevitably to a cascade of distress and more self-harm, Julie has gradually shown signs of partial recovery.  It is a literal thaw: in the immediate aftermath she is frozen in the horror of the moment, unable or unwilling to talk very much, moving slowly or not at all, unable to make decisions or take any pleasure in things.  She is still very tense, still rather quiet, but there is the occasional half-smile, she is getting out and about a little, she is making some small decisions.

Not to forget the part that Joe has played in this.  Joe having arranged to take a few extra days off work after Christmas meant that I spent much of the week in the office, while he has devoted himself to Julie.  Never was there a more devoted carer, taking the trouble to keep her interested, keep her active, remembering to dress her wounds, taking her to clinic appointments.  It has been wonderful to see, and I am only sorry that when he returns to work next week, they will no longer be as close.