I had an appointment yesterday with a psychiatrist. The plan was to get someone to manage medication, no therapy. I selected a him randomly off my insurance’s website. Well not completely randomly. I took location into account and avoided names similar to names of past therapists. But it wasn’t credential based.
I allowed an hour for the 15 minute walk to his office. So I killed time in the area, anxiously watching the clock.
When I got to his office he handed me a Zoloft branded clipboard with a paper to fill out my insurance info. I took the clipboard to be a good sign. Normally I’d look down upon something like that, but in this case all I want are drugs so a drug clipboard seems appropriate.
His office was the biggest psychiatrist office I’ve ever seen. It’s bigger than where I live. It’s bigger than my parent’s master bedroom. The rent on an office that big in that neighborhood must be insane.
He was familiar with my old school. He kept talking about how selective it is. I don’t know if he was just saying that to try to make me feel more comfortable, but it worked. I was going to that school for a very small specialized program. People with no connection to it’s field often don’t understand that it’s hard to get into. Lower acceptance rate than Harvard. There’s usually an unspoken assumption that I transferred to go to a better school. In reality, selectivity wise my new school is a step down. But they really can’t be compared because they have such diffrent focuses. But it was nice to have my achievement of acceptance into that school recognized.
I went through my history. All seemed to be going well. That’s the problem with mental health professionals. I always think it’s going fine, because they hide what they’re thinking. A normal person would give me a reaction if I were making them uncomfortable. I’d have signals to go off of. In this case all seemed fine until I mentioned my self-injury. Then he started getting squirmy. And it went downhill from there. I should have not mentioned the self-injury. It’s not even that important. I was struggling to find the balance of telling enough to ensure he wouldn’t say I don’t need the drugs but hiding enough to not scare him. I fell into the scaring him territory.
If I keep making mental health professionals uncomfortable how can I even think of having friends I can be open with? These people don’t realize how much they reinforce my fears when they do something like this.
I know I make myself seen crazier because of how I talk about everything I’ve been through. I tell it all very emotionally detached. Blunted affect. At times my voice might waver a bit, but not for long.
He said I was placing too many conditions on him about what I wanted. I know what I need and want. I’m sorry if I’m not a person who does something just because a doctor says to. I have to look out for myself. I will not blindly follow a person no matter what educational qualifications they have. I can listen to advice, but at the end of the day I decide what I do.
He wasn’t feeling comfortable with me not being in therapy. He didn’t want to be responsible for me. The problem with first appointments is that all the bad stuff comes out first. It’s not until after that people are able to understand that while at my worst things are pretty bad, on a day to day basis I do quite well. I managed to make him feel a little more comfortable mentioning I was thinking of meeting with my past therapist over the summer.
He asked me if I’d left a past therapist because he’d stopped writing prescriptions. He hadn’t. I resented the question. I am very strongly opposed to recreational drug use. I don’t drink alcohol or coffee. I made a point of making this appointment before I ran out of drugs. So I could meet the psychiatrist during the first appointment and not need to ask for a refill. So it would be clear that drug abuse is not a problem.
The appointment ran 20 minutes late. I guess it was nice of him not to kick me out, but I don’t think that extra time helped much. I managed to make him feel a bit less scared of me, but he wanted his own conditions to work with me. He asked to talk to my old therapist (the one who I want to meet with this summer) so they could try to “work something out”. That’s so vague. What does work something out mean? I was digging my nails into my arm to keep from crying. I pulled out my phone to give him the past therapist’s number. Then he said not to make an decisions now. To think about it and call him next week. He also said I should call my old therapist first.
I’d been planning on putting off the phone call to my old therapist until mid-may. I figure I won’t know when I’m available for an appointment till then anyways so it didn’t make sense to call.
This new psychiatrist didn’t make any guarantees of working with me if I make this call. He could still make the decision to not work with me.
These people they don’t want to work with me because they’re worried about being liable. The irony is that then they leave me with nothing, putting me in a far worse situation. Ditching clients who seem too difficult should also make someone liable. There should be some responsibility to find a person comfortable with working with me. Sure most people will give a list of referrals. But generally I call those and none have openings or they don’t take insurance or they also are scared of me.
I’m not sure if I should put up with this new guy’s demands or find another one. Next time around I can hide more. It’s so hard to know what to hide. Everyone has diffrent thresholds.
I guess it’s nice that he didn’t flat out 100% reject me, but he nearly did and still might.
I just wanted to get away from this therapist drama and simply ensure I can continue getting prescriptions to maintain status quo. I guess that was too much to ask.
Knowing I don’t have any way in the near future to get a klonopin refill makes me feel the need to conserve it. Which means there will be situations when I should take one when I won’t. In general I take it less often that I probably should. When I don’t take it sometimes things escalate to worse levels, but it’s hard to tell the difference between a time when it will escalate and a time when it won’t. That’s scary. That I could be left without a thing that can help me because I’m more messed up that he expected me to be. Because I am more messed up and therefore need help more, I am less able to receive that help.
Tales of a Crazy Psychology Major 
Wow, you told him about the SI on the first appointment? I think it’s great that you were so open and honest, but as you can see all of that honesty can bite you in the ass. I tell on a “need to know” basis with my psych. Just tell enough so you get the drugs you need. I know it’s unethical of me, but if I know what I want and what I need it’s what I have to do.
He accused me of being too closed off! I have trouble expressing feelings in the absence of describing behaviors associated with them. So I think that makes me a little more likely to share things like SI early one. I also just have a lot of practice because I’ve told my history so may times. The difficulty saying some of these things has become minimal.
I have trouble gauging how much is okay to tell in what situation. I tend to go from the extreme of saying nothing to saying much too much. Especially when I don’t have cues from the person to help guide me about where the limit is.
I know nothing about the should and should nots of psych. appointments. I have my first one coming up – thanks for the heads up.
That’s just awful. It’s like, you try so hard to do the right thing, to be honest and “lay all your cards on the table” and this is your “reward”. i am so sorry you had this awful experience. i am similar to you, i have this tendency to answer all questions honestly. i think you should try someone else and not wait for this guy to get his act togerther…if he e v e r does. Best of luck to you and BTW, i love your blog and the way you write…thanks so much!
Yea, it’s like they’re trying to get me to be more secretive. You’d think therapy would strive for the opposite.
Glad you like the blog:)
When I was talking about “need to know basis” that was strictly with my psychiatrist, not my therapist. I consider what they each need to know vastly different. I think it’s important to be totally honest in therapy if the goal is to be healed. With a psychiatrist the goal is to get the meds you need, and sometimes you have to take a more conservative approach. Just wanted to clarify that.
Yea, I get the distinction. unfortunately it’s a little too easy or me to generalize this experience to mental health professionals in general because I already had something similar happen before with a therapist (mentioned in the therapist list post)
Honesty is important. It just often gets reactions that are negative.
Long comment warning, but – I joke that I’m a serial therapist jumper because I went through several before I found one who can handle the tough stuff without getting squirmy or making me go in-patient out of liability concerns. They do exist – a dying species, it seems (hence my joining you in the “crazy psych major” department…) but they are out there. I actually wound up with my current therapist because she’s primarily a psychiatrist and I was so poisoned to therapy, I didn’t want sessions, I just wanted drugs…now I get the opposite, naturally.
I can relate to the clinical rattling off of symptoms and behaviors, and being so open about it all that the psychs can’t seem to wait for the hour to be up. I’m sorry to hear the appointment was such a negative experience.
It’s not until after that people are able to understand that while at my worst things are pretty bad, on a day to day basis I do quite well.
So true.
I just found your blog via your comment on Graffiti. I really am glad to have found it.
I was proud of myself a couple of months ago as I nicely convinced my doc to change my pills to the ones I wanted. And my depression is so much the better for the new tablets.
Personally, keep to the need to know.