Fear of cycle

I don’t think I can come up with words to describe how terrifying it is to me to not feel like I have a stable therapist situation. I don’t want to go back to my cycle of firing a therapist every few months but I also don’t want to be hospitalized. When therapy is unstable, the risk of me doing something impulsive that gets me hospitalized becomes much higher.

I wrote in my last post about #28 https://psychologytales.com/2013/09/16/lay-off-with-the-psychoeducation-28/

I feel like I’m taking a million emotional steps backwards.

I did about the best job imaginable explaining to #28 where the problems are in therapy with her. But still nothing has happened to give me even a tiny glimmer of hope that it could work out. To make matters worse we have to skip a week. So I have another week of being a mess and terrified about my complete lack of any support. I can’t stand the uncertainty about if this will work out.

I am too busy to have time to be this much of an emotional mess.

I think I would feel better if I had a referral I could hand on to to know it’s a option if nothing works. I literally can not find a single psychiatrist on google in my area who is not affiliated with my training program. I don’t know if I even have any other options at all, let alone one who will be a good match.

Lay off with the psychoeducation #28

I guess I was wrong about not writing in here. I have no where else to talk about this stuff.

I had a really terrible day at school. Worked very hard to avoid crying at school. Hung in there until therapy.

Until  today I’d really been feeling apathy about therapist #28. There wasn’t anything I really liked, but nothing I really disliked strongly either. That’s a problem because really there need to be SOME positive feelings towards a therapist to get things going even if it’s just something little giving some hope.

The part where any problems with therapists become clearest is when I come in having my first meltdown which was what today was. The only positive of the session is that I did a good job of telling her what she was doing wrong so there can be no doubt that I did not make a good effort to explain where the problems where.

She started off talking scheduling which was frustrating, because I was pretty clearly upset but somehow she was interpreting my being upset as be being stressed about my schedule.

I had been franticly working to hold things together all day and all my anxiety exploded out of me with me talking a million miles a minute about everything I had been trying to keep under-wrap all day.

Her response:  To tell me I am catastrophizing, define catastrophizing and talk about the problems with it.

I snapped back that I am well aware of what catastrophizing is and I do not need it defined.

Her response: Well with the way you are acting it seems like you don’t know it.

Me: I can understand things intellectually but that is not the same as being able to apply them.

I switched to jargon filled language (I usually try to avoid this in therapy) and explained all the ways I had attempted to handle my emotions. I had tried suppression, reappraisal, multiple types of distraction. I can know about these methods but that does not make them work.

Then I stopped talking for awhile. Frozen up with anger.

When I began talking again I told her that it felt like she was not being empathetic and that she was falsely assuming due to our number of sessions that we have more of a therapeutic alliance than we do.

Again, she responded poorly by asking sarcastically if she was “still on trial” and saying that I seemed to want too specific of a reaction from her to be realistic.

I told her that I had been containing these feelings all day and he first step was to try to stop me from expressing them.

The session ended awkwardly and even included a billing debate (I think she is accidentally overcharging me though a misunderstanding about my insurance).

The session was upsetting on so many levels. #28 felt very out of sync with me. She wanted to jump in and interpret but has awful timing. What’s worse is that her interpretation about catastrophizing is what I’d expect from a cognitive therapist. I’m going there looking for psychodynamic therapy. So I feel like I’m just getting cognitive therapy from someone without proper training in it, because a good cognitive therapist would have realized how terrible the timing of that comment was.

I feel like she’s evoking feelings in me that make me feel “borderline” and that she’s responding with the same thing in mind which I think it making her less empathetic. I’m getting angry over emotion invalidating things from her. Which is turn is making her think I’m excessively sensitive to feeling invalidated. The comment about being “on trial” really gets me. It makes it seem like it’s somehow wrong for me to be evaluating whether the therapy relationship is a good fit. I’ve seen her less than 10 times. It is perfectly reasonable for me to be evaluating how I feel about her. And if this therapy really is psychodynamic I should never stop evaluating that, because the transference should matter.

She responded to my anger about her defining catastrophizing as if I was offended that she thought I did not know it. This was not the case at all. I was upset that she was trying to shut down my emotions. It’s not so simple as turning it on or off. It’s not like I can say ‘Oh I am catastrophizing let me just stop now.’ and have it work. If I could do that I would not be in therapy.

I just feel like we were so out of sync and she was not able to adapt well from feedback (instead turing any feedback around on me as my flaw). I don’t know what to do.

I need someone who uses a good amount of warm Rodgerian skills. I need someone supportive. A therapist can not only be that though. I want interpretations but interpretations without warmth just gets you Albert Ellis.

I left SM a sobbing voicemail. I feel bad bothering him. I just feel so lost.

Sorry that this post is not on the level of posting that I usually try to create. I just have no where else to talk.

How fear of being un-masked dominates my thoughts: Hiding mental illness

I talked in the last post about impostor syndrome. I wanted to elaborate upon this a bit by showing how my thought process goes about participating in class discussions and how my fear of having my health health status discovered dominates my decision processes. This isn’t any one class but more an example of what my experiences in classes tend to be like.

Thought: I have to participate at least once each class. Ideally more, because participation is a large part of the grade.

[Professor asks question]

Thought: I have thought I would like to contribute to this, but the knowledge I have is based on readings I have investigated in depth in attempts to understand myself. Although I can respond to this question and keep the content intellectual and not personal, I worry that someone might wonder why I know so much about a niche area like this. I have to make sure the knowledge I convey all can plausibly be expected of me given my current training level. I know that for one question response it might not mean a lot but if they put together other pieces of information with my response they might start to suspect something. I’ll skip this one.

[Other student makes a comment]

Thought: I wish I could talk about the thing I am thinking of and add to the conversation, but it is not worth the risk.

[Professor discusses a diagnosis in the class which is one I have]

Though: Keep your face neutral, keep your face neutral. If a student says something stigmatizing and offensive keep your face neutral. If someone comments about frustrations relating to difficulty treating this population, keep your face neutral. Crap. I think I may have made a slight disgust face. Did anyone see? Does the professor suspect I have a personal relation with this subject matter?

[Professor asks a question related to a definition from the reading]

Thought: Good I can answer this! It falls into knowledge I am expected to know.

[I provide answer]

[I am asked to discuss my current research interests and directions]

Thought: I am doing me-search. I am very proud of the direction I am investigating, but is it too novel? Novel is good, but what if they wonder where did I get the inspiration for these novel ideas? I don’t have patients yet so I can’t claim it was inspired from working with them. What if people realize that the reason I am able to piece this research together in a unique way it is because I am using some of my experience (combined with extensive literature reviews) as a source of inspiration. I can down play the novel parts and make it look more iterative than it is but that hurts me by hiding something I can being successful at. But I need to blend in to avoid arousing suspicions.

[I discuss research]

Thought: Did I say too much? Are they getting suspicious? I should make sure I stop talking to avoid further damage.

[Class continues]

Thought: I need to watch my body language. Stop fidgeting. They’ll realize you’re anxious.

—-

Logically I know that these worried fall under the Spotlight effect, but I consider being found out to be such a horrifically terrible event that even if it is low probability I need to do all I can to protect myself.

Growing, Imposter Syndrome, and Starting Grad school

Long time without an update. I have been feeling like it’s worth making a post about where I am at now. I don’t think I’ll resume regular posting, but I’ve been thinking a lot recently about how glad I am that I wrote a lot of this stuff out here. I’ve looked back on old posts and can see that my feelings have evolved, but I like that I can access information about where I was at that point in my life. Since in the not far off future I will begin seeing patients of my own, I want to be sure that in my integration into the field as a professional that I don’t forget the vulnerability that comes with being a patient in therapy.

This isn’t to say I am recovered from my mental health difficulties. But I can see now that there are places where I have shifted to slightly more moderate perspectives. For example I now feel the need to ad more qualifiers to my feeling that in moderation, “There is nothing wrong with self injury”. More, now I feel that for me personally the risk benefit/ratio makes it such that it is not an area I feel is worth prioritizing for my treatment. That said, I have considerably decreased the frequency I do it at. But this has been more of an incidental benefit from improvement in other emotional issues. Also, I got a cat. Getting a cat has probably done more to decrease my self-harm than any therapy. For example today on my way home I was visualizing how I would cut as soon as I got in the door. But I walked in and my cat demanded my attention. So I hugged him and now I’m writing this blog post. Maybe I’ll cut later or maybe I won’t. It is hard to say.

I also am trying to be more open to DBT as a treatment. Not for me. But I need to recognize that it does help some people. I am going to make a specific effort to receive training in administering DBT. It’s not easy. Looking at the Marsha Linehan book on my desk makes my heart race. But if I can separate the emotions I feel about being bullied by DBT therapists and pull out the useful bits from that by identifying areas to be more sensitive about, maybe the negative experiences with DBT could make me more effective at administering DBT. That said, I don’t think DBT will ever be my favorite treatment modality, but I can recognize that some people find it helpful.

I’m also making as specific effort to not avoid things due to worries that they may increase the chances of my running into the therapist who kicked me out of my undergrad school. I’m not specifically trying to find events where I might run into him (that would be stalking), but if I am invited to attend an event and am debating whether I should attend, I am making an effort to not factor running into him into my decision. For example I was invited to a wonderful talk by my advisor that was put on my a small organization the therapist-who-kicked me-out-of-school helped to found. I was terrified he would be there, but also knew that the event could be beneficial professionally so I went. He wasn’t there. I’ve no gone to quite a few events where I was terrified of running into him and attended without problem. I’ve really enjoyed going to these events and am glad that I didn’t let the worry hold me back.

Even though a lot of time has passed the fear of being somehow unmasked and losing things I have worked for is still very strong. In my research assistant job I took prior to coming to grad school, those fears started to lessen over time. I reached a point where I felt I was contributing valuable enough efforts to the team that the discovery would not dimmish my hard work. But the fear never fully went away. It’s hard when the fear is partially grounded in reality. There is a risk that if my mental health history were known it would impact me professionally. The problem for me is that my fears are out of proportion and I end up hiding even more than is needed at the expense of forming close relationships. Part of what terrified me about dating is that during a breakup the ex could use information they have learned about me to sabotage my career. It has been  roughly 6 years now where I have been unable to form new close friendships. I rely only on the superficial friendships and the people I knew from before it happened.

Some of this maps onto Imposter Syndrome which is very common in graduate students but I feel that my experience is a step beyond what is typical. For the most part in the past with work and undergrad this feeling was limited to hiding my mental health history, but since starting grad school (I’m not even a month in) I feel like it has slammed me in the face. I’m surrounded by so many smart hard working people in my classes. Everyone has such great ideas and asks such clever questions. I am feeling very intimidated. I always tend to beat myself up mentally a bit about things I say, but the current intensity in highly elevated. I worry about not talking enough but then worry about talking too much and if I said stupid things. My anxiety is not usually as social evaluation focused, but this too is unusually increased. I feel like the most awkward one there. I normally don’t care much about the risk of being socially left out but now I’m terrified that I will somehow be ostracized from my cohort if I do something stupid. And then my general distrust comes in because I can’t tell if I am being invited to things because it would be odd to leave out an invite to one member of the cohort or if I am really wanted. Even caring about if I am wanted is a bit unusual for me. I am usually so independent. Things have just started so I imagine that the intensity I am experiencing these things at won’t be sustained, but I am worried that the intense emotions I am feeling will isolate me from my classmates in a way that can’t be repaired over time.

I had to move to go to grad school. I had to leave meeting with SM (the one therapist I made a good connection with). When I resumed meeting with him 2 years ago I tried to tell myself that it might be possible for me to not need therapy after the 2 years. That was not a realistic goal. So I am now meeting with therapist #28. The area I have moved to has a lower therapist per square mile density than I have had in the past. When I also factor in how many of the therapists in the area might be people I will encounter in my academic training I simply can not afford to go back into my cycle of firing a therapist every couple of months. There are just not enough therapists around form me to do that. So I am trying very hard to stick with #28. If I leave, I need to have a very good reason and need to try to not do it impulsively. This is tough because I feel that every therapist I have left I have had a good reason to leave and that it was well thought out. I know there’s no way for me to go through 28 therapists without me contributing something to the problem, but on an individual therapist level it is very hard to see it as anything other than a problem with one particular therapist.

I have only had a couple of appointments with #28 so far. It’s so frustrating to start over and so hard to gauge if things will work. Having a therapist like SM who saw me over a period of 6 years (although with large gaps of seeing other therapists during that time when I was living too far away from him) and knows the history and associations I have with different things and how some of my views have shifted is so valuable. In talking with #28 about some of the social anxiety I am experiencing I get so frustrated needing to interrupt my flow to throw in background information. I am trying with 28, but I don’t feel connected to her. Everything feels forced and unnatural.

She made a comment that freaked me out a lot. If she knew more about me she’d have realized not to say it. Going to avoid the specifics here to avoid identifying myself too much. But the simple issue is that she made an “if ___  then ____” relating to an action she might take if a certain thing turned out to be true. This is an action which would be undesirable to me. She told me this in response to my worrying about whether this thing might be true. It has turned out that the thing I was worried about is not true, but while I was still worried about that I had a new added worry about whether I needed to lie to 28 if it did turn out to be true to avoid her doing the undesirable thing. Sorry that is so convoluted. The simple issue here though is that she created a situation in which my providing her information might hurt me and made me need to consider lying in therapy. I hate lying in therapy. This is one of the things about no-harm contacts and such that infuriate me (that’s not what this was). Rather than help me deal with the situation they create an environment where I feel I can’t be honest which defeats the point of therapy. It’s tough to have an issue like this come up so early. I feel like if I am honest and say that it upset me and stressed me out because I felt like I might need to lie to hide it that she might think I am actually lying about the thing we had talked about before. But if I don’t mention it I get to stew over it and feel like I can’t have open communication. It’s so hard to get things to where I was with SM. If SM had somehow done the same thing I’d feel comfortable telling him and not worry about repercussions of my words. But in this new environment I am worrying that my words will be used against me. This type of problem is the kind of thing that I know is capable of building up into something that causes me to leave therapy.

SM and I are doing brief monthly check in phone calls to ease the transition. I get to talk with him Monday, right before my appointment with 28 so maybe he can help me figure out how to deal with it. The therapy transition is tough. I’ve been having so many new experiences and challenges that I want to be able to talk through with someone. I try to picture in my head talking to #28 about these things and the image and interest in talking fizzles away. But if I think about talking to SM it feels comfortable. Even in my imaginary visualizations of therapy he is better.

I do want to avoid having this end on a negative note. I am incredibly happy with the program I am in. Everything so far has been confirming that I made the right choice with this school. I just need to handle the anxiety enough to get the most out of it.