Why do I go through so many therapists?

It doesn’t take long of reading this blog for someone to notice that I’ve met with a lot of therapists.

I’ve made reference to reasons why I think this is the case, but never organized all those thoughts together.
This is certainly something where if I fully understood it that maybe it would no longer be a problem, but I’ll share with you my current understanding of it.

Looking at the whole picture, it’s obvious to me that I have an avoidant attachment style. That’s the common thread running through this.
I should be clear though that an avoidant attachment style is not the same thing as avoidant personality disorder. Some have tried to suggest I have this, but I really don’t think it describes me well. My problem is with intimacy in particular. There are a lot of things aside from intimacy, which I find anxiety provoking, but I tend to push through that anxiety and continue to do those things.
I find close relationships threatening. People who are too friendly feel to me like their friendliness is an assault. I feel like these people like me more than I like them and that they won’t give me the space I need. To clarify I am referring to primarily to platonic relationships here.

My concern about them not respecting my need for space it probably partially a projection about my relationship with my mother, but it’s also been further reinforced by others who couldn’t take a hint to back off. My mom has very little respect for interpersonal boundaries. I’m an introvert and she’s more extroverted. She’s the very needy kind of extrovert, the kind who can’t fathom that other people might feel drained by interactions while she feels energized by them. My dad would step in sometimes and tell her to give me some space. She’d agree to do that, but 5 minutes later she’d be back to the same thing. I’d have to physically hide places (like closets) to escape her destructive consuming affection. For her expressing love is not a two person interaction. It is about her and her insecurities. There is a general consensus among my family that she has some type of undiagnosed learning disability that impairs her ability to recognize that she is doing something interpersonally destructive.

Now a days I can just hang up the phone on her. I know that sounds awful. But calmly telling her to give me space does not work. And after I hang up I have to turn off the phone because she will call over and over. My email inbox gets flooded with one line messages.

A couple of years ago I was staying with my parents for a bit. My mom had bought a new computer, which I set up for her. She’s very computer illiterate. She spent a day pestering me with questions about it (very basic things like installing word). I helped at first, but finally told her to use the Apple support number, since we’d paid for it already. The Applecare person was less tolerant than I was and actually hung up on her. I wanted just a couple of uninterrupted hours to myself after playing tech support all day, so I locked myself in a room. I barricaded the door, because locks in that house are easy to pick. My plan didn’t work out as well as I’d hoped. Within about 5 minutes my mom was banging on the door demanding I open it. It’s important to note that there was no reason she needed to be in this room. If I hadn’t been in there she’d not have wanted to get in.
She quickly escalated to threats that she was going to kill me and alternated between death threats and threats of calling the police. I don’t really think she would kill me, but in the moment I wasn’t about to open the door for someone threatening to kill me, even if they were not serious. And if the police had come I think they’d have understood why I’d not opened the door. And what crime could I be charged with for locking myself in a room in the house I lived in?
I was having a panic attack and wanted to escape out a window, but I was in my pajamas and had no shoes. My dad was on a business trip and called demanding that I open the door. It turned out that he was simultaneously telling my mom that if she called the police he would divorce her. He was on no ones side. Eventually I was bullied by my dad into opening the door.
Thankfully the next day was the day I was scheduled to move into my apartment.

That got a bit sidetracked, but I think it illustrates a reason why I find close relationships threatening. My mom’s affection is very aggressive. I’ve never felt unloved and my parents do care about me, but the way my mom shows this is very overwhelming.

The problem with looking at my therapy problem as an attachment problem only, is that when I look back at each therapist I’ve left individually I can think of good reasons why I left each. Globally there’s a picture of attachment style that emerges, but individually it looks different.

There’s also the issue of how I’ve been treated in prior therapy, which puts me very on guard about protecting myself from bad therapy.
It wasn’t until therapist #4 that I actually started using therapy for myself. Before it was something that I was forced into by my parents. I started seeing her because my parents felt I didn’t have enough insight about my ADD. The therapy eventually evolved into a place where I talked more about anxiety and depression, but it took nearly 2 years of more superficial conversation to get to that. The therapy was helpful in some ways, but I hit a point where I reached the limit of how much she could help. She became very pushy about some things. I agreed to start seeing #5 for DBT in addition to seeing her, but that didn’t work out when he demanded I phone him before I self injure if I wanted to meet with him. The theme between the two of them was that I received ultimatums where I either had to do something they wanted or I could no longer meet with them. After I quit DBT, #4 gave me a list of things to pick from. I had to do one or she would no longer meet with me. I picked that I would have my primary care doctor look at my cuts regularly. I felt very bullied by this.
I did leave for a little bit and met with #6. #6 was so much worse that I came running back.
The final straw with #4 was when she told me she wanted me to do DBT all summer instead of the summer job I’d just been hired for. I went to the job instead and am very glad that I did, because it was a wonderful experience.
In a way my tendency to leave therapists easily, is a protection against this sort of bullying. If a therapist tries to threaten that I should do something or else leave, well then I’ll just leave. I’m sick of being pushed around. Threatening to withhold therapy is not a useful form of treatment.
An unintentional outcome of these experiences is that I’ve become a lot more assertive in my daily life. I will stand up for myself.

Then there was #7 who got me kicked out of my school and #8 who I met for medication who told the doctors at my first hospitalizations to lie to me about my diagnosis.
This whole experience made everything more difficult. Not only could therapy be something that might not help, but it also became something that could potentially destroy my career and life goals. While a therapist might believe their intentions are pure, ultimately I am the only one who can protect myself and I need to be on guard to make sure the helpers don’t hurt me.

I’ll skip #9 and #10 mostly because that therapy was for the purpose of getting a note to allow my re-admittance to school.

Then there’s #11. S.M. My favorite one. He’s the only one I left on good terms with. There’s some idealization going on in there. I’ve tried to hide it from him, but by now he knows. I don’t like anyone seeing if I care at all about them. I’m so used to feeling horrified by overwhelming expressions of affection, that I forget sometimes that in moderation people actually do appreciate being told they’re valued and needed. While I would feel threatened by being needed interpersonally (needed in a professional sense is fine) most people don’t feel like that.
I left because I transfered schools and the new one is far away. At the time I didn’t think finding a new therapist would be a big deal. I thought that all psychodynamic therapists were the same (I sure was wrong about that) and that all I needed was another psychodynamic therapist.
If I’d realized how much trouble I’d have finding someone else I would have put more effort into finding a school in that area. I do think though that there are ways in which I’ve grown, through this struggle that I might not have had I stayed with S.M. the past 3 years.
My idealization of S.M probably made sticking with a therapist harder. I thought for awhile that maybe these other therapists who didn’t work out were just the wrong kind of psychodynamic. I now realize that there is a huge amount of heterogeneity within any theoretical orientation. While I like the psychdynamic approach, it was probably things outside of the theory that made therapy with S.M. work.

Things are going okay right now with #27. I’ll wait and see what happens.

All of the factors mentioned here probably contribute to some of the difficulty I’ve had in finding a therapist. Explaining partially why I’ve seen 16 therapists in the past 3 years. There are probably others reasons I am not yet aware of. I know that because I’ve personally had so much trouble, that I am the common factor in this. It’s at least partially my own fault. There are certainly elements (systemic and therapist factors) outside of myself that also contribute as well.
Even though it seems that with each therapist I see they become a little more disposable, it is still devastating to me each time I leave one. That one or two hours a week is very important to me. This importance is part of why I need so badly to be sure I’m in a therapy that is getting it right. If therapy didn’t matter I’d just be content in something mediocre.

Primary Care

I used to believe there was never a legitimate reason to withhold information from a primary care doctor. Now I feel that information is only to be given on a need to know basis.

In late high school, my therapist (M.S.) gave me three choices, I could go on medication, go back to DBT or go to my primary care doctor to get my cuts looked at. If I refused select one of them, she wouldn’t meet with me anymore. I resented the ultimatum, but decided to go for the primary care option. Medication and DBT would be continued disruptions to my life but a trip to the doctor could be done and over with in a day.

I didn’t have any control over making my own doctor appointments or transporting myself to the doctor. My parents don’t know about my cutting so I couldn’t tell them why I needed to go.
I invented a vague medical issue (I can’t remember what, maybe a stomach ache?) and asked to go to the doctor. Given my Mom’s hysterical tendency to overreact to physical symptoms, this was all I needed to get an appointment.

I went to the appointment and no surprise, my cuts did not need medical attention, but the therapist didn’t trust my judgment.
I thought I was done with the primary care task, but the therapist kept insisting I periodically return.
More vague medical issues were invented. My cuts were fine. I make a lot of cuts, but the depth of each individual one is nothing to worry about.
One visit, my regular doctor wasn’t in and instead I met with an overemotional doctor who grabbed my arm and made me promise not to kill myself.

When I was hospitalized for the first time it was partially related to losing my virginity. Although I know that with lesbian sex the risks are lower, I decided to ask for a STD test. The HIV test was done while I was in the hospital, but the other more general test was not.
I was 19, but my primary care doctor was still my pediatrician. Google says that up to age 21 people sometimes still see their pediatrician, but for me age 19 felt much too old. I didn’t have control over making doctors appointments yet and hadn’t been comfortable asking my parents about switching. The doctors at the hospital helped me out by writing in my discharge report, “Recommend the patient establish care with gynecologist”.

Upon release from the hospital I had an appointment with the new primary care doctor. I got my STD test (Results were fine). That was the only appointment I ever had with her.

Much later, I was trying to find a therapist. A local hospital’s psychology department said they could get me one, but first I needed a primary care doctor in their hospital. I made an appointment to see this new doctor (I will call her Doctor A). I gave a fairly lengthy psych history to her, because I needed her to help me get a therapist within her hospital. She seemed very nice and insisted she’d help me get a therapy appointment quickly.
The hospital wasn’t able to follow through with getting me a therapist. The wait list was a month long and even after the wait I wouldn’t be able to have a high enough frequency of appointments.

Another local hospital said they too could find me a therapist if I had a primary care doctor in their hospital. Again, I went to a new primary care doctor who I told more about my psychological history than my physical history. This hospital was also not able to follow through on their promise of a therapist.

I decided to switch back to Doctor A because her hospital had a more convenient location. Both hospitals are affiliated with the same prestigious medical school so I believed they were of comparable quality. Turns out the USnews rankings feel strongly otherwise, but I didn’t know this at the time.

I had a handful of appointments with Doctor A. I needed a form signed for school, the HPV vaccination, I had the flu etc.
I wasn’t pleased with how she handled my medical form for my new school. She put much too much information down about my psychological history. I felt the only appropriate information was the medication I was on (klonopin) and a small reference to minor anxiety as an explanation. I didn’t feel comfortable using her form with what had happened last time I had a school know my psychological history.
I never gave my new school the medical form. I’ve avoided the student health center. I worried they would track me down looking for it, but it never happened.

My third hospitalization was at Doctor A’s hospital. The many ways that that hospitalization was the worst I’ve had are a subject for another post. When I was discharged they insisted I make a follow-up appointment with my primary care doctor. The next available appointment was many months outward. The appointment was made and although I felt it was unnecessary I kept in in my calendar book.

After the hospitalization at Doctor A’s hospital I requested a copy of my records. I really only cared about the records from my inpatient stay, but because I was already going through the effort of making the request I also checked the box asking for my primary care records.

In my initial appointment with Doctor A I had mentioned that I am a lesbian. I was also asked if I am sexually active. I find that a hard question to answer; I explained that I only had sex once. I was asked if it had been consensual and I told her it was. At the time I didn’t think much of the question about consent, it seemed like a reasonable follow up.

In my records I was surprised to find this:
“She has had one sexual encounter with a man 1 year ago, but has not had intercourse since. She considers herself a lesbian but does not have a girlfriend and is not sexually active.”

I definitely never said anything about having sex with a man! I’ve only had sex with a woman. At the follow-up appointment I called her out on this. She was very insistent that I had told her I had sex with a man.

She heard the statements “I have had sex once” and “I am a lesbian”. I think this was likely not conscious, but I believe she was biased to assume that “sex” is a man plus a woman even though intellectually I believe she understands the alternatives. So following that she asked the question about consent, because it didn’t make sense for a lesbian to have sex with a man unless it was rape. There are of course exceptions to this, such as when a person begins identifying as a lesbian later in life. Instead of asking for clarification she assumed I was one of those exceptions and entered the incorrect information into my record.

I wasn’t pleased to learn that my doctor had an implicit bias against homosexuals. I realize there are some leaps and assumptions in here, but I think it is the most logical explanation of what happened.

I decided I was done with preventative medicine. I have chronic suicidal ideation. Although I wasn’t going to take action to kill myself then, I shouldn’t take action to keep myself alive. Basic needs such as eating and sleeping were okay, but no need for check-ups. Maybe I would come down with a horrible disease and would die without needing the effort of killing myself.

Eventually, I loosened up on my boycott of preventative medicine. I found a new primary care doctor (Doctor B), one at a clinic with a focus on the LGBT community. I told Doctor B the bare minimum of psychological history; I let her know the medications I am on, and mentioned nothing other than occasional panic attacks and ADHD. That’s all she needs to know. If she doesn’t know more, then she can’t tell more on any forms I need her to sign.

In September when I had my most recent overdose, I wanted to go to a doctor to get checked out. I couldn’t go to to Doctor B, because I don’t want her knowing about my crazy.

I waited a week to avoid the risk of being forcibly hospitalized. The more time between me and the overdose the less of a case they would have that I was an immediate danger to myself.

Doctor A was a resident and no longer works in the same hospital, but the hospital assigned me a new primary care doctor who I have never met. As far as Doctor A’s hospital is concerned I still have a primary care doctor there. I just haven’t been to an appointment for awhile. This gave me access to their walk-in clinic.
I met with a doctor who insisted I needed an emergency appointment with their psych department. Because it was after hours and I wasn’t an immediate risk she said she’d call tomorrow with a referral for an urgent appointment. I didn’t argue because I didn’t want to say anything that might force me to stay there. But it was frustrating, because I’d come for the physical issues only.
Everything was fine physically in her tests besides my reported GI symptoms (they eventually faded away).
I dutifully followed up with all of the hoops to get the urgent appointment. I was without therapy so I figured it couldn’t hurt. The appointment never materialized. No surprise there.
I would probably go back there if I needed other medical attention related to my psychological issues. I don’t like them but they’re capable of running a blood test or giving an X-ray. Doctor B is still my doctor for yearly appointments and anything else .

I don’t know which doctor is my real primary care doctor. Neither has the full story. Each has their specialized purpose. It works, so I’ll keep it like this.

Research Participant

Being crazy can be profitable.
During the past two years I’ve participated in around 20 paid psychology research studies.

I have such a hard time talking in therapy, but research studies are easy. I don’t have to worry about their reactions to things I say. I’ll probably never see them again.

It might seem strange to do because I am so touchy about therapy confidentiality. I’ve never been burned with research study confidentiality. In my head I feel they take it more seriously, but that may just be a rationalization.

I never do treatment studies. I’m not comfortable with that. So no taking experimental drugs or going to excessively rigid short term therapy for me. Mostly I fill out surveys and do short activities or tests.

It’s not something for everyone. A lot of tough issues get brought up. The same detached, methodical approach that helps me here might be very upsetting for others.

It’s educational and helps me out financially. I get a sense of what studies are being done and observe their methodology.

Sometimes I spot flaws with the ways data is gathered. Tiny things that will never make it into the final paper but might impact the results. I make mental notes to avoid those in the studies my future self will conduct.

You’d be amazed at how many surveys with questions about sex are written in a heteronormative fashion.
I realize it’s not so simple to fix an empirically validated measure as changing one question. Whole new testing would need to be done to make sure the change doesn’t hurt its validity.

It’s also not always immediately clear how best to fix a question to make it more inclusive.

For example some social anxiety measures ask specifically about anxiety around the opposite sex.
For homosexuals the question can’t just be changed to “same sex”. The question isn’t asking about only people whom you might potentially date. It’s asking about the entire gender.
The type of interactions lesbian women have with straight women (the majority of women) can’t properly be compared to the interactions straight women have with straight men (the majority of men).
Changing the wording to “same sex” (as some research assistants have told me to do) changes the question’s meaning. And what about bisexuals? Should it just be changed to “everyone” for them?

It’s not so simple either to change the question to only address specific people who you feel sexual attraction to. Again this is a new question, because the original discussed an entire gender. A whole separate research study would need to be conducted to validate these changes.

Another problem is with risky behavior measures. Many ask about birth control. Yes, I have had sex without using a form of birth control, but I highly doubt either of us will get pregnant seeing as no sperm were involved.

It’s clear a number of commonly used measures need to be updated. I understand that people are opting to work with what’s available, but they also need to realize this might impact their results.
Lesbians who are less conscientious than I might just answer the questions (I mention the problem to the research assistant) without thinking about the context the questions are asked in.
These types of questions are not a rare occurrence.

On average my interactions with researchers and research assistants have been quite positive. I wouldn’t describe it as warm and fuzzy. It’s a business arrangement. We’re both clear on the expectations and everything works out well.

However, one particular researcher got under my skin. He was a lisenced psychologist, there to go through a structured clinical interview with me to determine if I qualified for their study. As we went through the questions he’d throw out unsolicited bits of advice and comments. Comments like how I shouldn’t self-injure, etc. Completely inappropriate.
I continued through the questions, answering honestly, but it would have been all too easy for me close off. If it had been therapy I would have stopped talking and stared at the wall. I kept going. The things I do to preserve the quality of data.
I considered dropping out of the study, but the pay was good and I only had to have tiny interactions with him after the first day, so I stuck with it. Everyone else in the study was great.

Often when people outside of the field think of psychology studies they think of studies using horrible unethical forms of deception. There’s so much regulation with IRBs that the risk of this is low. In the worst and only deception I’ve encountered in a study, I was told I was playing a computer game against a real person, but it was really a computer. Pretty harmless stuff, but they were still required to tell me it in the debriefing.

I’m very dodgy with telling therapists about my involvement in research. I participated in several research studies over the summer while I was in therapy with S.M. I went to therapy 3 times a week. In therapy 3 times a week, concealing activities becomes harder. I hid it up until the last week when I casually mentioned it, trying to be nonchalant while fighting off a grin. He handled it very well. I was worried he’d wonder why I had trouble talking to him, but could talk to researchers. It ended up being a non-issue.

Participating in these studies is something I’ve enjoyed, but I need to stop or at least cut back on it. I can’t have my professional life merge with my crazy one. I’m getting to know more local people in my field. The risk of encountering someone I know or who knows someone I know is rising.
I have one last appointment to participate in a study. The office is it in is one floor above where a number of people I know work. I did a Facebook search of the research assistant and sure enough we have a mutual friend. I’m going to go through with this study because I think the subject is intriguing, but it’s a warning sign that I need to cut back.
I don’t want to say for sure this is the last one, but I will definitely be doing fewer.

Adderall and Ritalin

As you can tell from my post about food, I am very particular about what goes into my body.

It was an ordeal for my parents to get me to take any kind of medicine as a child. Any occasion where I took medicine was a rarity. I had no understanding of the cause and effect. The idea that something I ingest would alter how I felt (possibly in a positive way) was hard for me to understand.

My freshman year of high school my parents decided they wanted me to begin taking Adderall. I refused initially. I wasn’t worried about potential risks of the drug. Taking a doctor prescribed drug as directed seemed harmless. I knew cognitively about the idea of side effects, but had no personal experience and therefore was not concerned. My reason for objecting was taste.
I’ve never learned to swallow pills. I have to place them in food. The bitter taste is inescapable.
My parents offered to pay me to take the Adderall. I forget how much. It was a one time payment in exchange for taking the drug indefinitely. I’m not much of negotiator, I probably could have gotten a better deal, but I accepted it.

I began the Adderall.
I have no memory of ever being told by a doctor what side effects to look our for. My parents were told, but I wasn’t.
So when I stopped needing to eat or sleep much I didn’t connect this to the new drug. I just thought I didn’t need these things anymore.

I’d sneak over to the computer at night and play games online. Go to bed at 3 am wake up at 7:30 am? No problem!
I loved my alone time at night. I had free reign of the house, provided I was quiet.
Why would I tell my parents? They’d just get mad at me for sneaking out of bed.

I didn’t need lunch anymore. I’d save my lunch money for various odds and ends.
Couldn’t tell my parents that either, they’d get mad.

Classes were boring. I’d look around the room going pondering the different ways I could kill myself before the class ended. Could I jump out the window? Hang myself with the flagpole? It was half serious and half a game.

I exploded at a friend at school. She asked where my boyfriend and I were going on our date. I accused her of trying to follow us. I never repaired that friendship following this incident.

I started self-injury during this time. Was it something that was bound to happen even without the Adderall? I have no way of knowing.

Based on how long standing my problems have been and my family history I believe I’d still have had difficulties without ever taking Adderall. I think they may have just been accelerated.

During this time I feel something in me broke. I’ve spent the rest of my life trying to fix it, but I never get back to where I was. I have times when I think I am fixed, but a little bump makes me fall apart again.

My fabulous, amazing godfather commented that I looked drugged. And he would know, what with all the time in the 80s he spent being punk rocker, hanging around the east village.

There were a lot of dramatic, loud arguments with my Mom. One resulted in my running into a snow storm in only a t-shirt and jeans. I figured I’d freeze myself to death in the snow. I hid in the backyard, then I got cold, so I decided to live.

I re-entered my home. My dad was on the phone with a local psych unit. Had I stayed outside a few more minutes I’d have been dragged to the hospital.
This was my first threat of psych hospitalization. It began a series of nightmares I had for years about being forcibly hospitalized. (This is a topic for another post)

I wonder sometimes how things might be different had I been hospitalized that day. If some type of intervention had been made earlier would things be less severe today? My parents were and still are for the most part clueless about how bad my problems are. It was a year until I began regular therapy and it wasn’t due to a specific mental health diagnosis except for a little about my ADD. It was primarily for dealing with conflict between my mom and I.

After the snow storm incident, my parents finally realized the Adderall was not the best idea for me and I was taken off it.

Life improved after quitting the Adderall, but never quite to where it was before. The self injury tapered off, to the point where I thought I was done with it forever. There was almost a year where things felt close to normal. A rough patch during my junior year brought everything back. It was much easier to fall apart the second time.

You’d think this would have scared me away from stimulants for good, wouldn’t you?
It did for awhile. It scared me away from all drugs.

Out of desperation, my freshman year of college, I tried some other psych drugs for my anxiety and depression. (This is a topic for another post) This loosened up my fear somewhat. I’m still very distrustful of drugs, but if desperate enough I’m willing to look into the option, occasionally.

When I transfered schools I was terrified about how I would do academically.

During my second hospitalization I asked my doctor if he could prescribe an ADD medication besides Adderall. I thought it would be a good idea to try it while there so if I had a bad reaction I would be in a safe place.
The doctor said no. He had a theory that I was bipolar type 3 (didn’t seem to care that this diagnosis doesn’t exist) and thought it would make me manic.
In art therapy I spaced out while the directions were being explained. I dedicated my piece of colorful scribbles to him and called it “My therapist won’t give me ADD drugs, so I spaced out during the directions”. In typical art therapy fashion the facilitators talked about how even though I’d not heard the directions, my scribbles somehow related to the assigned topic.

During my 3rd hospitalization I asked again. They put me on Ritalin. Was the only helpful thing to come out of that hospitalization. Originally they had me take it every day. I wasn’t comfortable with that.
Now I take Ritalin just on days I want to. I like being able to compare how I feel on the drug versus off it. It has worked out very well.

Everything in my brain organizes itself better. I don’t stare at a blank screen for hours trying to start a paper.

It’s not perfect. I’ve had horrible mood swings when it wears off. I learned this happens when I skip a meal. I make sure to eat (even if I’m not hungry) and things are fine.

Careful self-monitoring is important.

Ritalin is shorter acting than Adderall. I find this helpful. I can’t go for weeks accidentally depriving myself of sleep and food like I did on Adderall.

Part of my Adderall problem was that I wasn’t informed about anything. I was 14. I was young, but old enough that I should have had a more active role in my health decisions. Someone should have let me know that my body still needed food and sleep even if it was saying otherwise.

Relationships, Dating, Sex

All names in this entry have been changed.

In late elementary school there was Sam. We played soccer together at recess. He liked me. I don’t remember my feelings for him, but I didn’t have a problem with him. I gave him my email address, which was also my mom’s email address. I didn’t have my own yet. He sent me something that I gather was in some way sexual. I never read it. My mom got to it first. I wasn’t allowed to talk to him anymore.

In middle school there was Jay. We were friends. He wanted to be more than friends. I kept thinking the boundaries were clear and then he’d break them. I’d not talk to him for awhile, then eventually he’d apologize and we’d be friends again. I’d hear rumors saying that he and I were dating and get upset. It eventually became apparent that he was the one starting them. This dynamic continued into early high school. He invented a cousin who supposedly had a crush on me. Supposedly his cousin had met me a number of times, but for some reason I couldn’t ever remember him. Probably because this cousin didn’t exist. Jay would make sexual advances toward me on AIM and when I’d get mad he’d claim his cousin had hacked his screen name and apologize. Jay also was focused on converting me to Christianity, despite my clear disinterest. He’d say things like “I want you to be Christian so we can be together in heaven forever”. It was pretty creepy. Eventually I stopped putting up with him, but I should have broken off contact much sooner.

My freshman year of high school I had my first, and only, official boyfriend. Matt and I dated for 6 months. He went to a neighboring school and neither of us could drive, so I only saw him about once a week. I believe if we’d gone to the same school the relationship would have been significantly shorter. Everything was drawn out because our interaction was so far apart. I hadn’t yet realized I am gay, because I hadn’t yet realized what it meant to be sexually attracted to someone. I viewed Matt more as an accessory than anything else. He’d always want to talk on AIM between our dates. He was the emotionally needy one, and I the emotionally detached. On our dates we’d usually see a movie, there was minimal talking. He didn’t believe in sex before marriage which worked very well for me since I didn’t want to have sex with him. I did confide things in him. I told him about my self-injury. Years later I learned he’d been sharing things I confided in him with friends at his school, thinking I’d never find out, because I’d never meet them.
At some point he decided he could fix my depression by giving me an orgasm. He presented me with this idea and I shot it down. Eventually I was talked into it, through a bit of deception. He told me he also self-injured. Somehow that made me feel more of a connection and decide to go along with his idea. The whole situation was incredibly awkward. I didn’t know what was going on. I was very naive. Lots of awkward fumbling around in each others pants, never removing our underwear. I later realized that I didn’t have an orgasm that night, but that didn’t stop him at the time from telling me I had. I’m pretty sure he broke my hymen with his finger then, but he doesn’t think he did. Later when pressed for more information he backpedaled his statement about self-injury. He said he’d gotten hurt accidentally and just hadn’t been bothered by the injury. Not the same thing!
There was a period of time where he didn’t get a lot of sleep. He became paranoid. He was worrying that I would run off with a certain Japanese rock star and abandon him. Looking back I realize this was likely a reaction to him realizing he was much more interested in me than I was in him. Around this time we broke up, on AIM. I was fairly unaffected by it and I’m told he moved on not long after.
Years later at a high school graduation party I saw him for the first time since before the breakup. We talked, things were a bit awkward, but civil. He had heard that I’m gay and worried for a time it was his fault. It’s not. We friended each other on facebook. He now lives less than 10 blocks from me. Occasionally we get lunch and/or play video games. There’s always a bit of awkwardness, I don’t feel 100% comfortable being alone with him. He’s been respectful though. I don’t like that when we eat places it’s a battle to split the bill. He always wants to pay. That feels too much like a date. I do like free food though and he tends to take it personally to not accept him paying. I’m never fully clear about if he does this with all his friends, as he claims, or if our history is a factor. He pays with credit card, so I battle him by picking places only accepting cash and then I pay for both of us. He’s a nice guy, despite some issues we had when dating. I can see why of all guys to date I picked him. He’s very meterosexual.

After coming out of the closet I went to a lot of youth pride type events. ‘Youth pride event’ is code for ‘All the queer kids hook up with each other event’. I’d go to a dance, see everyone pairing up and feel left out. So I’d find someone and we’d start kissing. Numbers would be exchanged and then nothing would ever come of it.

I had a friend, Kim, who I went on a couple of dates with. We mostly sat in coffee shops and checked out other girls together. I’m pretty sure that’s not how dating’s supposed to work.

At pre-college there was Molly. It was again one of those situations where I naively wanted just to be friends but she felt differentially. I have a small lag time with processing auditory information. A lot of times pretend I understood information before I really did. I’ll hear sound and know an response is needed and will smile and nod, while still working on understanding the sound. I made the mistake of doing this when she asked me if I wanted to go out on a date sometime in the future. Not wanting to hurt her feelings, since we were friends, I decided to deal with the situation by not backtracking on my earlier response and just making sure the date never happened. Pre-college would end eventually and all would be fine.
One day we went out to lunch, not a date, and she asked me if that could count as our date. Feeling trapped, I decided to go along with it, because then at least the date would be over with. Then she kissed me and next thing I knew, we were making out on her bed. I won’t deny I was enjoying it for a bit, but then I panicked and spent the rest of pre-college hiding from her.

My freshman year of college there was Rachel. I met her via Craigslist. I made a post that started off by saying, I am a self-injurer. I figured I could get that part out of the way while I was anonymous. If someone had a problem with that, they didn’t need to reply. The rest of the post was filled with fun random facts out me to offset the self-injury information. Rachel responded, also referencing a history of self-injury. After googling her email to confirm she wasn’t a serial killer, we went on a date. Then we went on another date. The day of the third date, I was feeling depressed. I considered canceling, but decided going would be better than staying home to mope. We got sushi and were having a good time. She had an errand to do after and I tagged along because I was enjoying her company. She invited me to her apartment to watch a movie. I accepted the offer. I didn’t realize this meant having sex. If I’d been watching this interaction on TV it would have been obvious, but in my real life where I’d not had any physical contact with her besides a hug, it didn’t occur to me. We ‘watched’ a movie in the sense that there was a movie on, but neither of us was watching it. We kissed, a lot. I was enjoying myself. Then she misinterpreted a hand movement as an attempt at trying to remove her shirt. So that came off and well if her shirt was off, then mine should be off too, right? So then there was no clothing. I was feeling out of my comfort zone, but also curious. Things, kept progressing. I’m sure if I’d said I wanted to stop that she would have. I wasn’t pressured. I just never said no.
Post- sex conversation was about Cascading Style Sheets and other areas of web design. I think this is an excellent sort of post-sex conversation. I headed home, trying to process the past few hours. I ruminated excessively on it. Also keep in mind that I’d been feeling depressed prior to the date. I felt overwhelmed and panicked. I wish I could better describe it, but I don’t fully understand my reaction still. A week later I was hospitalized for the first time.
Rachel visited me when I was in the hospital. It was really nice of her. She didn’t know the role having sex played in my being there, I never told her. Her visit helped bring me a bit back to reality. I’d forgotten how nice she is and had been viewing her as threatening. Then I was kicked out of school for the rest of the semester, so I wasn’t living near where she lived.
When I returned she’d left. Then I left to transfer to my new school and she returned. She invited me to visit her. I mentally prepared myself. I knew we would have sex and I wasn’t going to let myself freak out about it. I was going to enjoy it. And I did. It wasn’t the most amazing thing ever, but it was some fun.
She suggested changing our facebook relationship status. I was thinking “It’s complicated”, since we were living far apart. Somehow it became “In a relationship”. Once it’s on facebook it’s official.
We made plans to visit each other. None of them happened. We hardly communicated. I was fine with the minimal communication to an extent. I so easily feel suffocated. I didn’t feel suffocated here. A girlfriend located over 4 hours away with conversation less than once every 3 weeks. 5 months into the ‘relationship’ she sent me a facebook message breaking up with me. She pulled the classic ‘it’s not you it’s me’ and cited the lack of communication. I wasn’t suprised or terribly upset. I adjusted my facebook status and that was it.

I’m not interested in dating anyone at the time being. It doesn’t seem worth the effort.

Trichotillomania

Trichotillomania. I can’t spell the words “schedule“, “definitely” or “regularly” without the help of spellcheck, but I can spell “trichotillomania“. It’s a good thing, because wordpress’s spellcheck doesn’t recognize trichotillomania as a word.

Trichotillomania (compulsive hair pulling) is the one diagnosis I have that all mental health professionals I’ve met with are in agreement about. I, however, feel very out of place in internet communities for those who share my diagnosis. I don’t pull from my scalp, so my problem is more easily hidden. As a result, I don’t suffer from the social consequences that many people have to deal with.

My favorite hairs to pull are ingrown ones. They don’t belong. They’re already defective, they are guilt free pulling.

First I notice the irritation of the skin. Sometimes I can see the hair sometimes I can’t. When the area is more inflamed I poke it with a pin to release the fluid. Digging with tweezers, pins and fingernails I search for the hidden hair. Sometimes blood obstructs my work. I have to allow a day of rest before resuming.

I question the existence of the hair. Maybe I already pulled this one out and forgot? Maybe the skin was irritated from something other than a hair? Was that a shadow or a hair?

After some healing, I recommence my hair retrieval mission. When finally I free the hair from my , then mutilated, skin, I feel immense satisfaction. The greater the length of the hair the greater the satisfaction. The visual is very important to me. I study it wondering how long it had been hiding in my body. Sometimes dead skin is firmly attached to the strand. I slide it off carefully, examine both hair and skin individually and dispose of them.

I replay the scene over and over in my head, eagerly awaiting my next opportunity to repeat it.

Nose hairs are my second most favorite type of hair to pull. They are also the most uncomfortable to discuss. There’s such social stigma about putting fingers up a nose, pulling out a hair there is even worse. I can comfortably tell therapists I pull pubic hair, but often omit the nose hair.

Using tweezers makes me sneeze, so fingers are the way to go. I wonder about the risks of pulling a hair with such an obvious purpose (filtration of the air). I justify it by pointing out to myself, ‘I can’t reach all of them to pull. The ones farther up are still in place functioning.’ I don’t seem to get sick more than average so I suppose it’s fine.

Eyebrows and eyelashes are the source of the most post-pulling-guilt. I start with light tugs. The hairs coming out in my hands are ones that were about to fall out anyway, right? If I’m not careful this quickly escalates into harder tugs. Now it’s uneven. I have to keep pulling to even things out, right? I have to finish the job. It’s all or nothing. Fortunately, I’ve had this more under control in recent years. I started wearing makeup more often. Mascara makes it easier to accidentally pull more hairs in one tug, but seeing the mascara on my hands helps to remind me to stop. Seeing eyeshadow on my hands when pulling eyebrows helps the same way. Wouldn’t want smudgy makeup, would I?

I also pull arm, leg and underarm hair. These are the socially accepted places for hair removal, but I take it to an extreme. Shaving feels like cheating. The hair is still there. I want it gone. I am in a constant struggle to remove it all. There is always that one hair I missed. I remove that and then there’s another.

I use an epilator (basically electronic tweezers) to remove it. I advocate epilators as aggressively as some women advocate diva cups (diva cups freak me out by the way. I bought one and it sits in my desk unused). Epilating is a very soothing experience for me. Unfortunately is as a noisy device. I try to minimize the time I use it when others are home. I don’t want people realizing how much time I spend removing hair.

At times when I don’t have access to an epilator I will eventually begin pulling out the hairs individually. I can tolerate a certain amount of hair, but I have a limit. That limit is lower when stressed. At my first hospitalization I reach that limit. The staff didn’t understand my situation and wouldn’t let me use my epilator because it had a cord (no wires allowed. I could strangle myself -_-). They also misunderstood my trichotillomania as a type of self-injury. I was individually pulling out my hairs, gripping them with my finger nails. I reached the point where I was wiling to compromise with shaving. I couldn’t have a razor to shave either, because I cut. My roommate, who was allowed to shave, took pity on me and allowed me to use her razor on the condition that she supervised to see I didn’t cut. It was very much appreciated. I was eventually allowed access to the epilator under supervision from staff.

Let me elaborate on that point I just made. Trichotillomania is not self-injury. Some people might pull their hair as self-injury, but that is not trichotillomania.

When I self-injure I want to see destruction. When I pull I aim for perfection.

I self-injure as a direct response to stress. I know I will release that stress by self-injuring.

I often start pulling without even noticing. While stress may play a role, it is not the entire explanation. I pull at times I am bored or have inactive hands as well as in reaction to stress.

What they do have in common for me is the importance of visuals. I have to see the hair I pull out, just like I need to see the damage from my self-injury.

I tend to pull more with my right hand than left, which is interesting as it is my non-dominant hand. Pulling with my left hand feels strange.

I have some ideas regarding environmental root * causes for my hair pulling, but I’ll save that for another post.

*ahah poor word choice

The Therapist List

I mentioned in my previous post that I had met with “many” therapists. The word “many” fails to capture the vast number of therapists I have met with. I’m at the point where I repeat office buildings when looking for new one.

I have met with 20 outpatient therapists. This isn’t counting the ones I met in partial-hospital programs, the ones who I met with only once for the purpose of a referral, or the ones who I met with for neuropsychological testing.

I have an appointment with number 21 for Tuesday.

Here’s the list:

1. ADD Guy –  I met with him a handful of times in early high school when my parents wanting me on medication for my ADD. I wasn’t really clear on the purpose at the time, but my parents signed me out of school to see him so I didn’t complain. I liked him. My parents had me stop meeting with him to switch to someone closer.

2. ADD Woman– I don’t remember much about her except that I sat in the appointments being pouty with my arms crossed while my parents talked.  She prescribed me adderall which was a disaster and I stopped meeting with her when I stopped the adderall.

3. Family Therapy Lady– It wasn’t really family therapy, it was just my mom and I. We’d each meet with her individually for part of the appointment and then we’d all talk together at the end. It was awful. My mom and I would arrive not fighting and leave fighting. It ended when I sat through an appointment and refused to talk.

4. M.S. – I met with her for most of high school, sophomore year though senior year. Initially I didn’t really talk to her about much. But Junior year I told her about my self-injury and things changed. She helped me in a lot of ways, but there was a point where I hit her limit. I stayed meeting with her past the point where she could still help me. At the end we got stuck with her trying over and over the same things that didn’t help. I left and came back a couple of times and a few months before graduating I left for good.

5. Lady with the office near school – I met with her briefly when I had angrily left meeting with “M.S.”. She was so much worse, that I came running back to “M.S.”

6. DBT Guy– “M.S” asked me if I wanted to do a “group therapy” it sounded like an interesting idea. The group therapy turned out to be DBT. The group was full, so it was decided I’d meet individually with the group leader until a space opened up. I didn’t stick around long enough to get into the group. I couldn’t stand it. I met with him 2x a week for a bit over a month. He said things like “If you’re depressed you should be grateful that the ground is there to hold you up”  which as you can imagine wasn’t helpful. The final straw was that he wanted me to phone him before I was going to cut so he could talk me out of it. I have anxiety about phones, so the idea of calling when already anxious wasn’t appealing. I also don’t really 100% know if I’m going to cut until after it happens. So if I had called and then not cut after the call. I’d have felt guilty like I had been faking it. He didn’t understand this and said he couldn’t meet with me unless I could agree to that. So I stopped meeting with him.

7. College Therapist– I met with him as soon as I began college. It was convenient becase he was in the school’s health center. The first appointment I was visibly shaking. I ended up liking him a lot. But then he broke my confidentiality and got me kicked out of my school as a result of it.

8.Quick Diagnoser– She was a psychiatrist who I met with a couple of times when meeting regularly with “College Therapist”. She was very quick to throw diagnoses at me without getting the fully story. I only met with her a handful of times. She prescribed me Seroquel and Wellbrutrin. I ditched the Wellbrutrin pretty fast because I hate being on a drug regularly, but took the Seroquel as needed for awhile. When I was in the hospital she told my doctors there to lie to me about the Borderline diagnosis because she thought I’d freak out about it. I stopped meeting with her after “College Therapist” got me kicked out of school.

9. Social Worker– I met with her once after returing to my hometown to live with my parents after being kicked out of school. I was horrified that she didn’t know what Trichotillomania was and didn’t make another appointment.

10. Fake Therapist– I met with her during the time I was kicked out of school. I needed her letter to recommendation saying I was okay to return. I had a lawyer working on it too, but the letter from a therapist would help my case as well. The problem is that meant I couldn’t talk about anything without worrying that it might hurt my ability to get get good letter out of her. I had to say enough to make her think I was cooperating, but hide enough to protect myself. It was fake therapy. I didn’t tell her about my friend killing himself during the time I was meeting with her because I was worried that could be used against me. After all having a friend kill themselves is one of the classic items on the list of warning signs that that person might also be at risk. The one thing she did do that was helpful was switch me from Seroquel to Klonopin. Klonopin is much better because it doesn’t make me sleep all day. I left meeting with her when I returned to school.

11. S.M.- He was the best therapist I’ve ever met with. He introduced me to the psychodynamic approach, a refreshing change from things like DBT. I can’t really sum up how awesome he was in this little paragraph. He restored my faith in therapy after having had it destroyed by “College Therapist”. He helped me realize that majoring in psychology was an option. He doesn’t realize that though. I’d had an interest in it before, but had so much anger over bad therapy experiences that I felt studying it wasn’t an option. I left him when I decided to transfer schools to switch majors and to escape the drama that had followed my return to the school after being kicked out. I thought for sure that as long as I had a psychodynamic therapist near my new school that they’d be near as awesome as he was. I was sad about leaving him, but not anywhere near as sad as I was later when I had trouble finding a good therapist. If/When I move back to the area where he works I’d like to meet with him again.

12. Couldn’t afford her fee – “S.M.” recommended her.  Then it turned out my insurance didn’t cover her the way I thought it had so I couldn’t meet with her. So I only went a few times then left.

13. Home Office Guy – I met with him once and liked him even though the idea of  a home office seemed creepy to me. I was prepared to meet with him regularly, but then at the end of the appointment he said  he ‘couldn’t meet with me’, gave me a list of two names and sent me out the door. I have not a clue what happened there.

14. Repeat after me– I met with her for about a month. I tried to give her a fair change, but she drove me crazy (more so than I already am). Al she did was rephrase back to me what I had just said. In moderation I don’t have a problem with that. I understand that it can be soothing, but there is a limit and she went far beyond it. I told her that I wanted therapy that was more on the expressive end of the expressive-supportive continuum and she repeated that right back to me, not grasping the irony that repeating what is said is a supportive strategy.

15. Guy who couldn’t hear– He was old, his hearing was going and I speak softly. It was a bad match so I didn’t last long.

16. K.L.– He was a convenient walk from where I lived. I met with him for about 6 months. It got stuck fairly early on though. I stayed largely because the security of knowing I had a therapist can keep me somewhat stable even if the actual therapy doesn’t help. Early on in therapy I bought a book he had written. I didn’t like it much. I never told him I’d bought it. I decided to give him the benefit of the doubt. Even if he wasn’t a good writer he could be a good therapist. But things got stuck. All it felt he did was ask me what I fantasized about. And when I said ‘I don’t know’ (I have trouble with generalized questions. More about that later.). He’d rephrase it and ask what I daydreamed about. As if the minor word change would change my answer.

17. Nice Smile Therapist– I found him on a online therapist finder. I liked his smile in his photo. It seemed really genuine, not fake the way a lot of therapist smiles look. So I made an appointment. I went through my life history. And he told me that I made him “too anxious” for him to be able to work with me. I was really crushed, because it’s rare for me to go into an appointment with a new therapist feeling positive about it.  I think that because I was feeling more positive I may have shared things more quickly than I would have normally. I guess though that it is good he decided that on the 1st appointment rather than on the 10th.

18. Secret Agent Therapist– I called him this because the instructions to get to his office were very complex and involved secret codes. He scared me a little bit because he didn’t put up with any crap from me. But I also appreciated that. The problem was that he didn’t have a regular time in his schedule open for me. He assured me there would be one soon. So I met with him whenever there was a cancellation. I liked him because he actually believed me when I said “I don’t know” in response to a question.  He helped me figure out that it’s generalized questions I have trouble with and that rephrasing to something more specific can help. For example, not asking me ‘what’s your favorite type of movie?’ and instead asking ‘Did you like that movie?’ He theorized that it was related to a problem with executive function. Which seemed logical because previous neuropsych testing I’d had found problems with that. The problem was a space never opened up for me. He eventually told me he couldn’t meet with me because it didn’t seem like he’d have a regular time or me anytime soon. And this turned out to have probably been a good thing, because my dad didn’t like him. He’d done something that my dad considered shady with how he’d billed the insurance company an my dad is still trying to untangle his mess.

19. Rock Band Guy– “Secret Agent Therapist” referred me to him. I had trouble talking to him and spent the entire appointment talking about the video game rock band. I figured that if in even the first appointment he couldn’t get me to talk about real things, then in the long run it wouldn’t work out.

20. M.G. – I met with him a few months. Up until a week and a half ago. I mostly was meeting him him because I felt worn out from the whole searching for a therapist process. He didn’t believe me about the whole having trouble answering generalized questions thing which was frustrating. He just didn’t get me. Every interpretation he made was way off base. He’d jump to conclusions and I’d tell him they were wrong and give a reason and he wouldn’t budge. When I’d vent about  a problem he’d make me leaving feeling much worse. So I got frustrated and left.

Wow that took much longer to type than I thought it would. I should be doing my Cognitive Psych HW.

Anyways I hope I’ll like the new one I see on tuesday. I’m not sure if I can afford her though. I have to figure out insurance stuff.

Every time I see a new one they feel more disposable.If this one doesn’t work I’ll go buy a new one. I try to give people a fair chance. It just keeps not working out.

I keep thinking ‘this one is the last one if they don’t work I’m done with therapy’ and then I still end up going looking for a new one.

Updates:
21. No clever name – I left saying i wanted to take break and then she reacted so negatively to me wanting to take a break that I decided I just didn’t want to come back at all.
22. Scared him off– Post about it here
23. C.H.– Post here and also here.
24. CBT therapist– Basically setting this therapy up to fail by picking a therapist who has loads of traits I’d normally avoid.
25. Post here
26. Post here

27. Therapist who I travelled really far to get to.

28. Therapist who I started seeing upon moving for grad school

29. Current Therapist