I’ve seen more therapists than I have years that I’ve been alive. I started therapy when I was 14.
How am I? Oh well I’m emotionally dysregulated. How are you?
I’ve gone and fired therapist number 25 before I even had a chance to write an entry in here about the start of therapy with him. I met with him for 2 and 1/2 months or so.
Only a handful of sessions in I started to feel really attached to him. It terrified me, because that doesn’t usually happen and was and felt way out of proportion to how little he knew me.
That idealization was crushed shortly after. Because I felt over-attached, I rushed into some tough topics.
I think an important role of a therapist is to keep an eye on the patients level of affect and ensure that it is neither too low or too high. The optimal rage is different for everyone every day. Too low and the therapy is too superficial, but too high and it will be too overwhelming to be therapeutic. The optimal level varies based on how much time remains in the session. As the session nears its end the therapist needs to find the way to bring the affect to a level the patient can manage outside of the container of the therapeutic relationship.
I realize this can often be a difficult task, but he did about as poorly with this as possible. The session ended abruptly, leaving me in a vulnerable emotional state. This left me feeling wary about the therapy, realizing that he and I were very out of sync. I picture this session as a chart where x is time and y is affect. We both started at low affect and his line was straight across with no slope, while mine got higher and higher.
We did talk about this after, but I think he took the wrong message from it. I wanted him to be more aware of when things were escalating too far, while he took this to mean he shouldn’t press certain topics at all.
A couple of weeks ago I wasn’t feeling great. I won’t get into the reasons right now, because retrospectively I’m embarrassed about how trivial they were.
I cut in the bathroom of his building before my appointment. I felt extremely out of control. I bled through my pants leg. I spent the session with my purse held over the blood spot so he wouldn’t see.
Obviously he can’t read my mind (Although once a therapist accused me of wanting him to do that, probably with some justification) but I really resented him for not noticing something. I always keep my purse on the floor rather than holding it. Clearly I wasn’t meeting with Sherlock Holmes for therapy.
He was so focused on convincing me that I shouldn’t feel how I felt, that he didn’t get around to understanding how I felt.
He asked me if I was going to be okay over the weekend and I very unconvincingly said ‘Yes’. He didn’t question it.
That weekend I was not feeling well. I had some oxycodone left over from a medical problem I had over the summer (This is a topic for another post) I took that, some klonopin and some seroquel too.
Unfortunately I only slept for 13 hours as opposed to forever.
This is the first time I’ve ever misused prescription medications like this. I felt incredibly guilty about it. I’ve always only used over the counter medications for overdoses. I feel like doing this is betraying a level of trust between me and the perscribing doctor.
I rationalized this somewhat by not going over the daily limit for the klonopin, and only doing so with the oxycodone, because I care more about the trust between me and my psychiatrist than me and random doctor from the hospital who will never know about this.
With a lot of reluctance, I told therapist number 25 about this, but it took me two sessions to fully get out. At the time when I told him about this I wasn’t feeling suicidal any more. I came early though to that session to plan out my escape routes in case he tried to hospitalize me and I needed to bolt. I tossed a hat and sunglasses and change of clothing in my bag as well.
I brought up the idea during that session that my period may be relevant to some of my more serious mood problems. I’ve brought this up before with therapists. I never really can feel sure. Is it confirmation bias? I don’t have a good way to keep track of if my mood changes around my period. I don’t buy into those mood monthly calendars. All self report measures of mood are highly subjective and because I wouldn’t be blinded to when I have my period I question their validity.
I mentioned feeling conflicted about this due to my identity as a feminist. I don’t really have a fleshed out coherent argument about my feelings with this, just an uncomfortable feeling. Somehow I think that if I say the words feminism and menstruation enough my feelings will be clear to everyone.
The feelings have something to do with the society wanting to view women as overemotional on their periods, the medicalization of a normal process and the validity of PMDD as a diagnosis, but again I’m not good at expressing myself here. I can see both sides of an argument about PMDD.
He seemed confused about why feminism would be relevant to a discussion of PMDD. I can handle disagreement, especially since both sides of the argument are dueling it out in my brain. But I was shocked that he wouldn’t even be aware of the possible relevance of feminism to an issue involving menstruation. He seemed very perplexed and I was horrified.
He did apologize the following session without prompting, but still it was unsettling.
Then to make things even more exciting and wonderful (note the sarcasm) The therapist who kicked me out of school (I need a shorter way to refer to him) was on a major news network promoting his book.
Every bit of publicity feels like he is taunting me.
I sent him 3 angry tweets from my twitter account. This twitter account is public and associated with my real identity (not my real name, but the username I mostly use an also people I know in real like follow me there). Probably not my most brilliant idea ever, but I’m leaving them up. If any person searches for his @replies they will know that at least one person out there is very unhappy with him. They’re vague enough that if a person didn’t know the background they would know I was angry with him, but the reasons would be unclear.
This means he now has access to most of my social networking pages. That’s fine though as I put my best foot forward on those, unlike in this blog.
When I went to therapy to talk about this I was very let down. Awhile ago I made a comment about how klonopin makes me stupid, which it does. The stupidity occurs in varying degrees, but to have any relief from anxiety thoughts rushing around, some of the good smart thoughts are slowed down as well. Sometimes thoughts can even be of both types.
I commented on how I had to stop what I’d been working on (Probably for the better as is it was slightly destructive) when the klonopin kicked in, because I wasn’t able to think well enough. He decided to take this time to argue with me about wither I am on the correct dosage. I have had the dosage fiddled with to the point of adjusting it by increments of 1/4 of the smallest pill size. This is the right dose. I’ve been taking it at this dose for a couple of years. I’m not messing with it. He was convinced that there is some ideal dose where I won’t be anxious or stupid. I don’t believe this is possible, because the two are so intertwined and the impact of the same klonopin dose varies depending on the day.
The comments felt accusatory too. Like he thought I was abusing it, although I have never ever gone over my prescribed limit. In the context of previously telling him about my oxycodone and klonopin adventures I was very sensitive to this sort of comment, because I feel so guilty about it.
He was taking a super ego guilt inducing role. My super ego is super at making me feel guilty already thankyouverymuch.
I told him about something I had thought of doing, but did not do and he took his guilt induction much too far. I can’t write about the details here, but basically he took a thought of mine and turned it into a worst case scenario. I tried to protest, but he kept making it worse and worse. The things he was saying were already fears in my head. I didn’t need him to give them credibility.
I have far worse thoughts in my head that I haven’t told anyone. If he reacts with such a judgmental extreme to something less horrible then there’s no way he can handle the worst of me.
I felt like he was treating me like he thought I was a sociopath. He was playing this role of a conscious for me as if I had none.
If he had even a basic personality conceptualization of me he was working from to base his comments he’d have realized that I am already very skilled at guilt.
I stopped talking. I stared out the window for a bit.
Then, I pulled out my Nintendo DS and resumed the game I’d been playing in the waiting room. Really juvenile, but I don’t care.
My brother called while I was ignoring the therapist. I refused the call, but then he called again and I took it, upping my rudeness level by +10. He just had a quick answer to a question I’d had about the game I was playing.
After about 20 minutes of ignoring the therapist although with the occasional yes or no answer to a question I said “I think I should just leave”. And I did. He asked if I wanted to make another appointment and I said “No”.
There wasn’t anything he could say at the point that could have made me comfortable continuing therapy with him.
I hate myself already, I don’t need a therapist thinking I am awful as well.
I rushed out of the building, worried that I was going to be followed or stopped by security. Psychiatry departments are never placed near an easy exit and I think we all know this is not an accident.
I arrived home and decided to take some ibuprofen. I think the reason I am still alive after all these years is that I am awful at swallowing pills. If I were better at I’d have succeed years ago. I had liquid gel filled capsule type ibuprofen. I decided that if I dumped the liquid out and drank it that might work.
Turns out this is the worst idea ever. I tried opening one up, but it didn’t work well, so I decided to just put it in my mouth and bite it. It was extremely acidic. I ran to the sink to rinse my mouth out to stop the pain. My mouth and throat felt sore after, like I’d been vomiting.
With that method ruined, I gave up to the time being.
It’s a few days later and I’m okayish now. I’m not being very productive with school work. I’ve mostly been sleeping and eating ice cream. I don’t know what I’m going to do about the lack of a therapist situation. I hate starting over again and again.
Wow, that experience really sucked. I’m glad you are feeling a bit better now. I loved your analysis of how a good t should keep an eye on the client’s affect to see how the client is reacting to his words and opinions and insights. Two weeks ago my t dropped a last minute bomb on me before I was about to leave. It was very painful for me. I emailed him about it and then brought it up last week in session, and he got defensive. Granted, I did confront him in an accusatory manner, but I suck at verbal communication, and isn’t he supposed to be the one who is good at it? The whole episode is still eating at me. You described the role of an ideal t in this regard perfectly. Thank you. And I hope you find a better t, you deserve a really good one. Sounds like you could be a really good one – are you a t yet by any chance? Because I could use a good one too.
Not a therapist yet. I’ve got about 7 more years before I can be licensed, so a long way to go. If nothing else I have a really good sense of a lot of ways that therapists can mess up and hopefully I can avoid those.
Oh my goodness, what an ordeal! First of all, I would have felt the same way about the lack of “noticing” by the therapist. It also, from what you’ve written, seems like he didn’t really “get you”. I had the same experience with school T – I never felt she got me.
Did your T try to interact with you when you pulled out your DS or after your brother called you?
I know you said you didn’t buy into the mood charts and honestly, I didn’t really either. I started it in February and there was never any noticeable reason or difference until about July when my mood started to very gradually improve. It was so gradual, I didn’t even see it until P-doc held it away from me at a distance. One thing it did show, was that my moods weren’t affected my period. P-doc I think was surprised by this. If you want to try a mood chart, I scanned them from the book I use and you can print them off/photocopy them if you wanted to try it. P-doc says “severe” depression would be that I don’t get out of bed for the day. Anxiety/Irritability/Mood Swings are on a 1-3 with 3 being the worst. The bottom part is to document if your feeling a certain way because of an event.
Here is the link: http://sanityisknocking.wordpress.com/2010/05/29/mood-tracking/?preview=true&preview_id=1101&preview_nonce=ce71e871a3
Have you ever sat down and made a list of all of your therapists and compare what you liked/disliked about the services you received from them? Maybe if you had a more definite sense of that, you could look more closely at what exact features you’re looking for and articulate them in the first session? Perhaps even give examples of things that have been “destructive” for you, such as the negative/lack of understanding you had with this therapist in particular. Such an approach is bold but I think that if your therapist can handle the forwardness, then maybe the could be a good therapist for you.
In regards to the therapist who got you kicked out of school. I would feel such rage about that. I would want to destroy him at every turn.
Yea, I have all this rage and I don’t know what to do with it. I feel like it’s become a part of my personality that I’m more edgy now than I was before this whole ordeal.
This blog is the closest thing I have to a list of all my therapists and what happened in that therapy. With one therapist I did try making a do and don’t list which I gave him. It didn’t help. So much of it is about how two personalities fit together rather than a specific list of things.
Yea. He definitely didn’t get me. I was trying to avoid those specific words because I feel like that’s what I say about every therapist who doesn’t work out. But that’s exactly what it was.
He said a few things after I pulled out the DS. Asked if I wanted to be alone, I shrugged and also asked if there was anything he could do to help and I said no. He also apologized, but since he didn’t really even know what to apologize so it was pretty meaningless. He also asked if he’d scared me which made me more angry because I felt that was him continuing with his playing my conscious role.
I’ll think about the keeping track of moods thing more. I think I’d have to do it differently than that chart. I think I’d want to at least record 2 numbers a day. A high point and a low point to capture the range since my moods can be all over one number is not going to tell the whole story. Like on Friday I had some super great periods and then I came home and cried and took a seroquel. Giving one number for a whole day feels overwhelming to me. Too much info to condense.
I wish there were Galvanic skin response measures priced at a consumer level because if there were I’d just wear one all day and use that as my data.
Even if you didn’t give your therapist a list, if you knew for yourself about specific situations, do you think you could verbalize to a new therapist saying something like…if we had a disagreement about something, how would you handle it?
For the mood journal thing I have, I actually do what you would want to do. For days when there is a big span between morn/afternoon or anytime, I write the high and the low together under/on top of each other. Not sure if that helps you but thought I would mention it. I only started doing that in July.
He asked if you wanted to be alone? I wonder if he was ticked about it all? But then to apologize? I don’t get it…
I’m sorry all about this happening. It was so nice to have a blog post from you. I really enjoy your posts. Wish it could have been a happier one for you.
I think he didn’t know how to react and was trying to say anything that might re-engage me.
I dunno I’m so fed up with doing this staring over thing. It’s terrifying though when I have thoughts and thing oh I can talk about that in therapy and then realize I have no one in my life I can talk to about it.
I worry that there is no one who can help and if that’s the case why the hell am I going into this as a career?
It seems almost cruel that some people get that “fit” on the first try.
I’ve been trying to come up with some sort of good idea or suggestion. When I was away for the year for grad school, I had looked into available counseling outside of the school. Turns out, there was nothing, even though I was living in a city bigger than where I currently go for therapy.
On our school’s website, it did say that they could refer students for therapy outside the school if they preferred. I was wondering if your school did that? Maybe their recommendation would start you off in a better place than random selection?
I’m not really comfortable even going to ask for a referral from the school.
I put in a call to an org that I’m hoping might help, but I missed when they called back and now we’re playing telephone tag.
Things are also becoming increasingly complicated with avoiding having my crazy bleed into my professional life. I don’t want anyone affiliated with where I work or at a place where I would like to work when I graduate. (this rules out most of my area)
The org I called has an amazing reputation but I have serious theoretical objections to them so there’s no way I would want to work there. But that also means getting therapy where I object to parts of the theoretical basis.
This most recent therapist and therapist number 23 both know people I work with. I’m so touchy about boundaries that things just get scarier and scarier the more people I know.
And the psych blogging world is smallish too.
There are so many ways the therapist who kicked me out of school is only one degree of separation from this blog. For all I know he already could be reading it.
I feel like the whole area all the therapists know my shit. I mean obviously there are more than 25 therapists in my area, but it feels like my info is out there for everyone.
I could give a tour of my area based on therapy offices I’ve been to and it would cover a large part of the area. In fact I recently moved and my new home is on the same block as a former therapist’s office. I walk by it everyday on the way to the bus.
I wish after I quit therapy with a person that I had the option to wipe their brain of my identifying information.
My mood definately changes with my cycle. I get really bad thoughts for a couple of days before my period.