Search terms answered #3: “how to interact with psych inpatients”

Today someone searched “how to interact with psych inpatients” and ended up here.

Here are my thoughts of what you should do.

-Treat them like humans.
-Recognize that mental illness does not necessarily equal cognitive impairment. So many people talk to adult psych inpatients like they’re children.
-Don’t push your own agenda on them. Listen to them, instead. Part of this means keeping boundaries. Don’t talk about that relative/friend who overcame their depression. Your inspiring story probably will just sound preachy.
-Often there can be a lot of miscommunication in hospitals. Don’t assume the patient is wrong, just because the chart or staff may say otherwise. All of my psych hospital records are filled with errors that impacted my care, but I never knew about because I didn’t know there was any misunderstanding until I read the records.
-When upset sometimes people need space and sometimes they need support. Ask them which they prefer in that moment, rather than assuming one or the other. There have been times where problems of mine have escalated because a mental health worker kept trying to talk about something while I needed space. One of the best examples of how to do this well was in a hospital where I filled out forms the first day about many types of situations and how I preferred people to respond to me in those situations.
-Remember that saying someone does a behavior “for attention” is never a full explanation of what is going on and is never an excuse to forget that they are probably suffering.
-Don’t forget that the quiet well behaved person can be struggling just as much as the more obvious acting out person.
-Try to understand motivations of problematic behavior.
-Don’t sit behind a closed door waiting for people to come to you. At the hospitals where staff stayed in the nurses station unless they had a specific task to do they were very inaccessible. In another hospital there was a desk more out in the open. So they could still get work done, but there was no wall separating them. They were approachable. You obviously can’t change how your work environment is set up, but you can try to minimize time spend behind the window. People who need you may not feel comfortable knocking on the door. When people only leave the room for a specific task then everyone is always too busy to help.
-Keep all information about events you’ve witnessed with the patient private from visitors unless you have explicit permission to share them. It can be easy to casually let things slip that seem benign, especially if the visitors are chatty, but you don’t know what everyone’s situation is and their relationship with that particular visitor. This might seem obvious, but in all my hospitalizations information has been shared with my family that should not have even though the only information I specially authorized to share was about coordination of care after the hospitalization and billing. This makes having visitors very anxiety provoking at a time when I obviously don’t need more anxiety.

There are a lot of don’ts up there. But I guess among all this it’s important to remember that these people are just people. There are certain professional roles you need to follow, but a lot of your interactions should just pull from your general interpersonal skills.

I’m sure people who read this blog have their own thoughts. Feel free to add some.

I missed my appointment: A bad day

I missed therapy this week. I’ve never missed an appointment before without having canceled over 24 hours in advance. At my work I’m amazed to see how many people just skip or for whatever reason miss their therapy appointment and I’d never been one of those people before.

The appointment was a little later in the day than I had been usually traveling to Second-Closest-City. I was excited this meant I didn’t need to wake up at 5:30. Sleep is amazing. The extra two hours felt wonderful.

I was feeling great and well rested. I had a cute outfit on. I was wearing a scarf that’s been in my closet for ages, unworn, and I realized it would look nice with a certain sweater.

I was nervous because I only had a 20 minute window from when my train was scheduled to arrive in Second-Closest-City and when my appointment began. I figured if the train ran 10 minutes late I could take a cab and make it on time.

At the train station my train was listed as on time and I waited at the platform. And waited. And waited. 20 minutes past when my train was supposed to arrive and it wasn’t there. Then they announced a different train arriving on the track designated previously for my train.

I looked at my train schedule and saw that my train was so late that taking a later, but faster, more expensive train would get me there faster. This train was listed to arrive in a couple of minutes so I ran up to the ticket booth only to discover that train goes through the other local station, not the one I was at. I ran back down to the train platform. My original late train had just left without the station announcing its arrival.

There was no way I could made it in time so I left the station. Then I glanced at my schedule. If I could get to the other station in my city really quickly I could make it to the next super-fast train leaving that station. I hailed a taxi and asked if he could get me there in less than 10 minutes. Then in the cab I looked closer at the schedule.
This train is the most expensive option to get to Second-Closest-City. It costs $50. That’s more than 5x as much as the train I originally planned to take. And I realized that even this train would only get me to Second-Closest-City 5 minutes before the appointment. I was going to spend $50, plus the current cab fare, plus another cab fare and still be pretty late. This wasn’t working out.

So I gave up and asked the driver to take me instead to my apartment. I was crying the whole cab ride.

We arrive at my apartment and I say I’d like to pay with credit card. The driver says his machine isn’t working well, but that we can try. I try and it’s not working. He reboots the machine, still not working.
Some important information about credit cards and cabs in my city: They are not legally allowed to operate without a functioning credit card machine. This driver shouldn’t have been operating the cab if he knew it didn’t work.
I understand why cab drivers don’t like these machines. They take a percentage of the profit. I try to be understanding of this and pay in cash when possible, because it’s definitely not an ideal situation for them.
But this law is in place so that consumers can have standards of what to expect across all cabs in this city. I didn’t have cash with me, but the standard is that they take credit card. Had I known he couldn’t do this I’d have gone with another cab. I could have respected his flouting the law if he’d been upfront and definitely wouldn’t have reported him in that situation. I would have taken a different cab though.

I was looking around the cab for the medallion number but could not find it posted inside the cab. I told him I only had half of the fare in cash on me and that it is illegal for him to operate the cab without a credit card machine. I of course didn’t have a phone on me, because I’d forgotten it at home and couldn’t call anyone for help.
Then we drove to an ATM. I probably should have been more scared about being stuck in a car with a disagreement with a strange man, but I was so stressed out already that I was just really angry instead of scared.
I took some money out of the ATM while he waited in the cab. I tried to get out of the ATM’s little room. It was one of those rooms where you get in with your bank card and all that’s in there is the ATM. The door was stuck. I kept pushing and could not get out. I finally escaped by kicking the door really hard.

I snapped a photo of the cab’s medallion number posted outside the cab and threw the money on the front seat. I included a tip too. I have such a problem with people who don’t tip that I even included one for awful service.

I walked home from the ATM and called my Dad, crying my eyes out, as soon as I got inside. It took awhile for me to say anything he could understand. I told him what happened and asked him to call therapist #27 to explain. I was so upset. And I hardly know #27. I’m not comfortable leaving him a crying voicemail message.
My Dad told me he was really busy and had a conference call in a few minutes. He later expressed annoyance that I’d called his work phone instead of his personal phone, even though he’s told me it’s okay to use that one if I’m really upset and need to reach him. Because he was so busy he said he would delegate it to my Mom. “No,” I said. I didn’t want her talking to him. But he did it anyway and my Mom called #27.

I got myself composed just enough to report the cab driver to the police over the telephone.

I still hadn’t technically missed my appointment yet, but obviously I was going to, as I am unfortunately unable to teleport myself.

Eventually number #27 called me. I spaced my words out very slowly to avoid incomprehensible crying. I don’t know if he realized how upset I was. If he did he didn’t comment. I made an appointment for after the holidays. He commented on how it seems like I’m putting myself through an ordeal to get to Second-Closest-City. And that was it.

I sat grumpily in my apartment for awhile and eventually decided to go buy some food. I tried to get out of my apartment, but the latch on the door got stuck. I kept pushing really hard and it didn’t work. I couldn’t get out of my apartment. I called my Dad crying again. He said he’d call back later. I kept playing with the latch. I was trying to figure out if I should unscrew the whole thing from the door, but was unsure if that would make a bigger mess. Finally, I’m not sure how, the latch decided to open and I escaped to get food.

At this time it was only 12 noon. I was really thrown off by the morning and spent the rest of the day moping inside my apartment instead of doing any of the errands I needed to do.

The people I work with would have no idea that this is how I am. They’ve commented numerous times about how calm I seem. I don’t feel calm, but somehow I look it, to therapists.


Also Searches Answered Segment #2
Search term: “is sticking saftey pins in your arm self mulitation”
Answer: Sounds like a yes. It is self-injury. Unless maybe it’s some kind of artistic body-mod thing. But I think if you have to ask it’s a yes.

Starting with therapist #27

So I fired number 26. No surprise there. I think it was a good choice. He really gave me a very bad vibe. If I heard on the news a few years from now that he was involved in some sort of cult scandal, I don’t think I’d be surprised. The fact that I keep making these types of associations about him like lawyer and cult leader are not good signs about a positive future therapeutic relationship.

I’ve now had 3 appointments with number 27.
I feel kind of guilty that recently I’ve just switched to numbers to identify them. I started off this blog coming up with cutesy nicknames for them and now I just don’t have the energy to care any more. I even have started telling them in an early session what number they are.
It feels like such an awful thing for me to do. Reducing them to a number. There’s definitely something in there about me not getting attached to people and keeping my distance, but I’m going to keep using the numbers anyway.

Number 27 is old. Really old. My first guess based on his medical school graduation year was that he is in his early 80s, but I redid my math later and maybe he’s actually in his late 70s. Still, very old. When I was googling him before the appointment; I thought there must have been two people with his name, because there was no way those really old articles were published by someone still practicing, but I was wrong.

If I’d not known this though before I met him though I’d not have realized his age. He seems younger than he is.
For an elderly psychoanalyst he’s surprisingly biologically based. He was a bit pushy about anti-depressants in the first appointment. I told him that I think anti-depressants are probably placebos******** and that if I am going to take a placebo I want it to not have all the side effects. Aside from this, I also am not comfortable with taking a medication every day, because of my scary experience with Adderall. He didn’t buy into my placebo argument and kept calling it my “opinion” in a kind of condescending way. I pointed out that this was more than just an opinion of mine and there there is considerable empirical evidence to support it, while there are ways people can disagree about it, it’s not just something I made up.

He responded to say that I doesn’t matter what I’ve read, because I don’t have his years of clinical experience as a psychiatrist. I bit my tongue and kept quiet about confirmation bias and the availability heuristic. But in the second appointment when he repeated about the same thing I made sure he knew that this idea had repeatedly been explained to me by clinicians from work and school, it wasn’t just something I’d read in the Time magazine article.

He said that it seemed like there were two things I was doing to make therapy more difficult, one is that I am traveling all the way to Second-Closest-City for therapy and the other is that I don’t want to take anti-depressants.
It probably didn’t help that I’d told him that I’d scored myself at a 42 on the Beck Depression Inventory the day before.
Pros: I liked that he viewed going to Second-Closest-City for therapy as a symptom, because I think it is. Number 26 was too full of himself of see that my choice to see him was part of a symptom. I think this is important.
Cons: He was pushy about the anti-depressants. I told him it is not a choice I am going to budge on and he didn’t seem to care. In the past this sort of thing would be an immediate red flag that I should leave, but I wasn’t feeling angry with him about it. Our conversation about drugs was on an intellectual level, not an emotional one. I’m okay if he wants to talk about it intellectually. I think it’s an interesting topic and am fine explaining the evidence to him.
I left the appointment saying I had not made up my mind about seeing him and would call. I left Second-Closest-City thinking I wouldn’t call, but as I thought about it during the rest of the day I decided I would give it another shot.

Appointments 2 and 3 went a bit better. He brought up the drugs again, but it was okay. Part of what is good is that I felt comfortable enough right away to disagree with him about this issue. If I’d silently been stewing over it things would be bad. But it’s in the open and we’re agreeing to disagree.

He’s really good at picking up on subtle changes in my affect and mentioning them. Then it lets us talk right away when I have a reaction to something that I didn’t voice. This is a really valuable skill, that is surprisingly rare among therapists. I don’t really know about how the rest of this will work out, but this rarity is in itself is a huge reason to be sure I give this a very fair chance.

******** I was really really hesitant to write about this here. I considered changing what we had disagreed about to something else, but felt that any way I might change it would lose a lot of meaning. I don’t want to get into an argument here about this with anyone. This is not the place for it. I’m not going to reply to any parts of comments that talk about if this is really the case or not. There is considerable evidence that anti-depressants are placebos and if you are interested in knowing about it there’s a very easy to read book here that walks you through the research. That said, a placebo does not mean that the drug is doing nothing. Both the control groups and anti-depressant group in the drug trials have a big effect, the problem is that the effect between the two groups is very small. You shouldn’t stop taking whatever medication you are on based on anything I’m saying here. The drugs do have very real physiological effects, with withdrawal symptoms and they may very well be helping you even if that effect might be placebo (but it might not be, science is never sure about anything ever. There can always be more evidence). Also I am not aware in depth about the research for SSRIs with anxiety and it is plausible that there could be a drug effect there (though I have no particular evidence to support either side).