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.

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Disclaimer:
******** 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).