Thanks

Thanks everyone who commented with support on my last post.
Just typing things out sorted some stuff out in my mind and made everything feel a bit more organized and less overwhelming so I started feeling better after writing it and from reading comments.

I’ve had a number of instances now in the past few months where I made an impulsive post here that I later deleted. I really want this blog to be less about in the moment freaking out and instead more looking at things about myself with some emotional distance.
Since I’ve had some instances where those messy emotion things have bled over into this blog they clearly are lacking a good place to go. Isn’t compartmentalization great? I get really jumpy about more ‘this is what is going on right now’ posts, because I think they make me more identifiable.

Would people be interested if I started a vent-y whine-y emotional blog that is password protected? I think I will also use it to tell about some things I’ve had to omit from here because I didn’t feel there was a sufficient way to disguise them to protect my privacy. There are a number of posts here where I had to leave out layers of complexity, because of my privacy concerns.
This new blog won’t replace this one, it’ll just cover a different area.
If so comment and I’ll make one and email you the link/pw.

edit: So the new blog is made. I’ve been sending out emails with the url and password to people who have commented.

Thought River

I’m having a rough time.
I’m sorry I’m not able to be as articulate when I’m very upset.
Here is my stream of consciousness.

High school English teachers used to get angry with me for writing in this disjointed way.
In my freshman year of college a prof told me my notes read like poetry.
I hate transition sentences and formal paragraphs.
Figure the transitions out on your own.

I don’t deal well with uncertainty
So many thing are up in the air right now.
I don’t know where anything will land.
I made an urgent appointment on Monday to see #27
and then saw him again at my regularly scheduled Tuesday appointment.
I need more support that that, but I just can’t travel all the way there very easily
It’s very time consuming.
I have so many commits and have done so little for them.
I’m using being busy as an excuse for falling behind on everything.
Oh sorry I’m overwhelmed doing X so I couldn’t get to Y.
In reality I’ve just been crying in my apartment.
My most productivity I’ve done the past week is writing two emails and scanning something.
I’ve gone out and physically been present at places I needed to be, but am not there mentally.
I actually went out yesterday and did something social.
A major rarity for me.
An old friend, from before I was crazy.
And I’ve been crazy for a long time.
She is is town for a bit and I insisted upon seeing her.
She doesn’t know my crap.
And she is going through some of her own crap, so I was able to forget some of my crap while taking a supportive role.
I had a good time.
Then came home and remembered everything.
Took some Klonopin and knocked myself out to sleep.
I need more support than I have access to right now.
I wish I could have therapy every day.
There’s just no way for me to get there.
All these ideas running though my head.

Maybe I could go to the school counseling dept and just only share certain information.
To supplement my real therapy.
Nothing about suicidal ideation or cutting.
Not about the bottle of suicide vodka in my cupboard
And the Klonopin I’m hoarding
That I’m saving for a synergistic drug interaction
There’s suicide grapefruit juice too, but I got thirsty and drank it as regular grapefruit juice.

Just talk about the terrifying uncertainty of not knowing anything about how my life will look in 2 months.
That’s socially acceptable.
I’m allowed to be stressed about this.
My stress is just out of proportion.
But it’s too complicated to hide bits in therapy
I did that with #24.
I refused to tell her where I worked or when to school
It got a bit ridiculous.

I easily meet the major depressive episode criteria
But what does that mater?
It’s all arbitrary
When is it dysthmyia and when major depression?
The DSM makes it seem clear, but it’s complicated

I laugh in classes.
I seem like I have a plan.
I’m taking it in stride.
I just fake it for a few hours.

All the therapists I see every day.
Not as a patient but as a colleague and student.
I hear them talk about self-injury and borderlines
Representing those with serious psychopathology.
No idea I’m there among them.
Well maybe I’m not borderline.
It all depends who you ask.
I feel offended personally when by derogatory statements against borderlines
Even if I am not a part of this group, I am perceived as a part of it.
The statement is directed at me.
Even if it is is not about me.

I did everything right academically.
Except for being crazy.
What else could I have done?
But nothing I’ve done matters.
I’m still in limbo.

The states are higher for me.
It’s not about a job and a career.
It’s about when I will kill myself.
My desperation is high.
I want it to work.
in that sense I want to live.
But I can’t stand the uncertainty.
I convince myself it won’t work and I should skip the waiting.
It was the same in high school.
I got into my first choice school.
Everything worked out.
Stakes are raised here.
I need to get back to seeing S.M. for therapy.
It’s not just a job, any job.
It’s a job where I can be happy.

If I have the time i would go to a partial program in the day
That’s the level of support I need
Not a hospital
Hospitals babysit
I’m not going to kill myself right now
But I need to keep things together so it stays that way
I’m envious of the UK bloggers who have access to this greater range of support services.
I just have therapy.
He’s (27) out of the office until Friday.
I didn’t listen to the whole voicemail message informing me
I hung up when I realized I’d have to wait.
He’s not that warm an supportive though.
More expressive on the expressive supportive continuum.
I need supportive now.

Crisis lines are only so helpful.
Awkward stranger pretending to care
Some better than others.
Sometimes i can ignore the awkwardness.
I hate giving background information.
I just want to pick up where I left off.
There’s a nice local crisis line, that allows that.
But their hours are few.
I always seem to freak out when they are closed.
You can leave a voicemail, they say.
But I’m scared to.

The national hotline.
The one that google recommends when you search about suicide methods
They connect to a random line.
Which is nice because calling specific ones I end up on hold.
Sometimes connected to ones where I’m not the target population.
Sometimes I get one where they say “Emergency Services this is ___”
I hang up, terrified.
I don’t want emergency services.
I just want to talk.
Don’t they realize they’re scaring people off with their greeting?

At the end of a crisis line call.
They have some time limit.
And they say call again anytime.
But I just feel rejected.
As they’ve kicked me off in the nicest way.

I have to go pretend to have my act together for the rest of the day.
Lots of talking and smiling and such.
So I’ll end this stream of consciousness post.
I usually put these in a more private blog, but I don’t think anyone reads that one.
Those are usually typo filled.
I tried to spell properly.
Some extra effort.
Just for you folks.
I’ll talk to you later.
And hope you’ll excuse the interruption from my typical posting format.

Blurry

Ever since I started talking to therapist #27 about how I’m looking for a job, he’d mention the same thing.

“You should look into the work Dr. X is doing.”

And I’d smile and say, “Sure I’ll look into that. Thanks for the tip.”
But I’d never write the name down. By the end of the session the name would be long forgotten. And besides I wouldn’t want to use the tip anyway.
I don’t want to get a job referral from my therapist. I haven’t reached that level of desperation yet. I’m so worried about privacy and boundaries, the last thing I want is a job I was refereed to by my therapist.

Imagine the interview, “How did you hear about this job?”
“Err.. Um.. Google?”

I applied to a number of jobs this weekend. One stood out. It matches my interests more than anything else I have applied to. It’s a bit of a stretch for me to get this one in particular, but I figured it was such a perfect match that I needed to try.

I mentioned this job application in therapy this week and described the job a little.

And #27 asked again, “Have you looked into the work Dr. X is doing yet?”

And then I realized Dr. X was the person I’d applied for that job with.

It’s not a huge deal. I probably won’t get the job. It’s a long shot. And even if I did I wouldn’t avoid it because of this. It’s too wonderful of an opprotunity.
I can’t keep things separate to the extent I want them to be. What’s the opposite of the mental health field? I should have decided to go into that.

Degrees of Separation

Two and a half years ago I participated in a research study. As you can imagine I wasn’t in the study as a healthy control. A small part of the study was recorded and I consented to that. At the time the field of psychology didn’t seem so small and incestuous. I wasn’t very worried about it, which really is out of character for me.

For the past year I’ve been stressed out a lot by the idea of that recording being out there. I went to a talk given by this researcher several months ago and avoided one of hers even further back than that. I hadn’t met her before, only a research assistant, but I worried about that recording. Had she seen it?

I debated back and forth about calling. If I called and withdrew my consent it could draw her attention to me. That could be worse than just leaving it and hoping it’s long forgotten.

Last week I heard some colleagues mention her name. I was surprised, because despite relative geographical closeness, her research is about as far away from what we do at my work as is possible for two areas within the same field. Turns out several of my colleagues are close friends with her.

As soon as I got home I dug through my file of consent forms to find the phone number of the lab where this recording was located and exact name of the study. The degrees of separation are now too few. I needed to call and have that recording destroyed.

It wasn’t until I found the consent form that I realized it was an audio recording, not a video recording. No one is going to recognize me from an audio recording. Relief.

Medical Hospitalization

I promised awhile ago that I would write about my medical hospitalization. This happened after I’d already had 3 psychiatric hospitalizations, so it’s interesting to me the similarities and differences that occurred between the two types.

I experienced a couple of symptoms that came on suddenly, one which was very worrysome and one which I wasn’t too worried about, but was uncomfortable.
The less worrysome symptom started while I was at a place I volunteer at. I’m not very good at listening to when my body tells me to stop something. I kept telling myself I would push through, I didn’t have much longer before I was scheduled to leave. Then the more worrysome symptom appeared and I told the supervisor I wasn’t feeling well. I rested in the break room for a bit hoping I’d feel up to going back to working. A supervisor offered to drive me home, I turned her down. Instead I took public transport.

I called my primary care doctor for an urgent appointment. My doctor wasn’t available, but there was someone else who could see me almost immediately. I saw this doctor and she told me what she strongly suspected the problem was. It was something unpleasant, but at the level I was experiencing it, not life threatening and she expected the symptoms would pass. She told me she’d make a referral for me to see someone the next day to confirm the diagnosis.

I was supposed to get a phone call soon about the exact time and location of the referral.

I went to class. I have to be doing pretty poorly to miss class. The professor noticed before the class that I wasn’t looking great and she kept commenting on how pale I looked. I was very insistent that I wanted to stay even though I wasn’t feeling well (there was no evidence that any of my symptoms were anything contagious). It was a long class though, a lecture followed by a lab. I made it through everything but the final hour. My poor lab parter was pulling most of the weight. I gave up though, I was too miserable to stay, so I left to go home. The professor was understanding.

This is very different from how things are with my psychological problems. I also went to class the day of my first psych hospitalization. There was nothing visibly wrong with me other than that maybe I was possibly quieter than normal. I’d not have been able to excuse myself from the class explaining to the professor that I was experiencing a lot of suicidal ideation, like I explained to my other professor this time about my worrysome symptom.

I hadn’t gotten any call about the so-called urgent referral for the next day. This is pretty similar to how primary care doctors have also treated my psych referrals

I went home and tried to sleep. It didn’t work very well.
I was feeling a lot worse than I had when I’d seen the doctor earlier. I was very stressed, because I had work the next day and no information about a referral (My work that day was flexible enough that if I’d ducked out for an hour to see a doctor no one would have objected) and felt worse.

I called my parents, crying. I feel like I do that too often for someone my age. They kept telling me to go to the emergency room.
I really didn’t want to go. Even though I felt horrible I felt that since I had already seen a doctor that day, who felt my situation was not an emergency, it didn’t make sense for me to go to the emergency room.
I worried that I wasn’t ill enough to go there.
This is pretty similar to how I’ve felt about seeking help for psych emergencys. I go back and forth between, ‘things are pretty bad’ to ‘but I don’t want to bother anyone’.

I agreed to go to the emergency room. The closest emergency room to me is the hospital where my 3rd psych hospitalization was. Nothing went right in that hospitalization There was not a chance I was going there, so instead I took a cab to one a little bit further, but arguably more prestigious.

I told the triage nurse, what was going on. I told her about the diagnosis that the doctor I’d seen had mentioned and how the referral hadn’t come through. I also mentioned how much worse I felt since I’d seen that doctor. On the pain scale I said I was an 8.
I’m a little unclear about the pain scale (and it’s supposed to be so simple!) I had thought that it was based on 10 being the worst pain I can imagine. I’ve since been told by some that 10 is the worst pain you’ve experienced. If I’d answered saying it was the worst I’d experienced then it would have been a 10.
This step was pretty similar to how things worked with triage at a psych hospitalization.

Then I was sent to a little room with a lot of other patients. I’ve been to the emergency room a number of times in my life for things like broken fingers, a broken foot etc. This room reminded me of the types of rooms I’d waited in for those situations. It was the group of people who could theoretically wait forever in the room without dying. I waited for about 3 hours in there. I called my parents again, crying. I told them I was going to leave, because based on how I’d been triaged they didn’t seem to think my problem was that serious. I was in a lot of pain and I figured that if I was in a lot of pain and the doctors didn’t feel it was an emergency then I may as well be in that pain at home in my comfortable bed.
I sat around for a little bit and finally asked the nurse if maybe there was a cot somewhere I could lay down on because, my pain was so much worse when sitting upright.

This is very different from my psych emergency room experiences. I’ve gotten a bed right away. Sometimes that bed was just a bed in a hallway, but it’s still a bed. Still a ton of waiting to be seen by a doctor, but they’d never put a psych patient in a room with a lot of other medical patients and only one nurse. In the psych emergency room I’ve always had a “sitter” watching me too. Here I don’t think the nurse even noticed my sobbing phone call. If I’d walked out I doubt anyone would have noticed. At a psych emergency room though you can’t just change your mind. You’re stuck there at least until you see a doctor.

I was seen shortly after the nurse found me a cot set up in the hallway. I’m not sure if this was because I’d made her more aware of how awful I felt or if it was just because I’d already waited 3 hours.

I was wheeled into another room and saw a lot of doctors and had a lot of tests. The original diagnosis the doctor told me at my primary care office was wrong and sent the ER docs on a bit of a wild goose chase while they ruled it out.
This period of time was very scary, because I didn’t know what was wrong with me. As soon as I saw a doctor I was given pain medication, so at least I was more comfortable physically, but I still didn’t know what was wrong. Many diagnoses were thrown at me as possibilities. Some of these were very serious chronic illnesses.
This is very different from a psychiatric hospitalization, where differential diagnoses are rarely discussed and it’s hard enough to even get the doctors to admit the diagnosis they’ve selected for you until maybe the end of the hospitalization. Here, diagnoses were discussed right off the bat and I was informed of reasons why they considered them.
I also saw a lot more doctors here than at any of my psychiatric hospitalizations. The most I’ve ever seen at a psychiatric emergency visit is 2 doctors and that’s only because there was a shift change.
Here I saw 4 or 5. There wasn’t a lot of waiting time in between either. Once I was past that initial 3 hour wait I had a steady stream of events, from doctors, to nurses to tests.

In my psychiatric emergency visits I’ve sat in a room by myself for nearly 24 hours with no form of entertainment, because they take your possessions, and maybe 20 minutes total of conversation with anyone working at the hospital. And this was at a supposed top tier hospital.
Here I had come prepared and brought my laptop. I was able to use the hospital’s wireless during the chunks of time where nothing was happening.

For medication they put an IV in, which is different from my psychiatric hospitalizations where my medication was taken orally.
For one of the tests I needed to drink contrast fluid. I have a bit of an oversensitive gag reflex and tend to vomit a bit too easily.
I vomited right as a doctor was walking in, because I was trying to drink the fluid. The vomiting wasn’t a symptom of the immediate problem. This is something I deal with regularly when trying to take medications. Nonetheless a nurse rushed over and gave me a medication through the IV that she said would help with the nausea.
It’s a scary thing for a person to so easily put a drug into my body, before I can even realize what is happening. I didn’t have a huge objection to it, but if she’d asked me first I’d have told her it was not necessary.

In a psych hospitalization this would be a lot harder to do. Worst case they could give someone a shot (this has never happened to me), but it would be a bigger deal to do and there are more safeties in place when giving something like this without explicit permission from the patient. It’s not done so casually.
During the course of this hospitalization I received all sorts of medications and I have no clue what any of them are, except for the morphine. In a psychiatric hospitalization I know everything I take and refuse anything without significant research ahead of time.

I contacted my work to let them know I was in the hospital. I don’t know what I would do if this had been a psychiatric hospitalization. I’d have probably had to lie. I wouldn’t feel comfortable telling them about that even though my work is in the mental health field. Actually, especially since my work is in the mental health field.
No one was going to judge me for this transient medical problem, but a long term mental health problem is not safe from judgment.

Eventually a diagnosis was found and treatment was planned. I was admitted to the hospital and moved from the ER. I felt a lot better knowing what was wrong.

The problem was something that was life threatening if left untreated, but not a big deal at all with access to modern medical care.

There is a part of me that mourns an opprotunity wasted here. I always have some level of suicidality and have at times wished I’d come down with something life threatening so I could die passively by just avoiding treatment. At the time of this illness, I was doing very well psychologically, but I wonder if I’d have stayed home instead of going to the ER if I’d been more depressed.
The uncertainty though is what drove me to the ER. Not knowing what was wrong freaked me out.
If I’d been more depressed and at home and known with high certainty the diagnosis (If I’d even glanced at Doctor Google I’d probably have come up with this diagnosis) I can’t say for sure that I’d have sought treatment.

Several years ago I once saw a primary care doctor at this hospital. I needed a psychiatrist referral (Don’t I always?) and could only see one at her hospital by going through a primary care doctor first.
I can’t remember exactly what I said, but I believe I gave a fairly thorough psychiatric history to her.

All through this medical hospitalization they had access to those records. I was really pleased with how that knowledge was handled. It probably helped that the records were old, but I don’t feel like I was treated at all like a person with a psych history.
I was asked 1 time how my mood was and once it was clear that I was fine, it was never asked again.

They also knew my current medications, both of which are psych medications. I was asked a number of times if I needed either of them while I was there, but I think that was more due to confusion because it’s unusual for someone to take Ritalin only some days like I do.

I was relieved that my self-injury wasn’t discovered/discussed in the medical hospitalization (It’s probably in the record from the primary care doctor). It helped that I had no fresh injuries. If anyone noticed the scars no one said anything. I was terrified of having a psych consult sent to me.

Everyone was so much more accessible than when I’ve had psychiatric hospitalizations. I had a button to call the nurse. In psychiatric hospitalizations I might walk around looking for a nurse and knock on the nurses station door to be told someone would get to me eventually. Unless it was a huge emergency, anything could wait. With the medical hospitalization, getting help when I needed it was easy.

In my hospital room I had a roommate. Unlike in a psych hospitalization, I have not a clue what she looked like. There was a curtain between us. All I know is that she was an elderly woman and that she had been there for awhile.
She was very disoriented and spent the night talking to herself.
While that might seem like it would be similar to a psychiatric hospitalization, it really wasn’t. In my hospitalizations someone that disoriented was usually given a single room instead of a double.

The largest difference between the two types of hospitalizations was length of stay. For the medical hospitalization I was there two days, counting my time in the ER. That’s shorter than the time you can be held involuntarily without a court order for a psychiatric hospitalization!

My shortest psychiatric hospitalization was one week long. They wanted to keep me longer, but I signed one of the forms requesting they either release me or get a court order. They realized they couldn’t pull off the court order so they backed down and released me.

After two days of the medical hospitalization I was very ready to get out of there and they were very ready to kick me out, so we were all on the same page.
I did spend a week at home recovering more, but at that point the worst was over. I just slept a lot.

Follow-up was also different. I’ve never had a psychiatric hospital discharge plan that didn’t fall apart within a couple of days of leaving. Then I’m left with no one to call and zero follow-up.

With the medical hospitalization they gave me an appointment at the hospital the following week and I could have continued to go to follow-up weekly as long as I felt necessary. Personally, the one follow up was all I needed. I was even able to call a number they gave me for when I had a question or ran into an issue about the treatment plan.

I’m all better now. It was an interesting experience to have a medical hospitalization after all of the psych ones.

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.

——————
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).

An adventure to Second-Closest-City and Therapist #26

Last week S.M. contacted me with a name of a potential therapist. The one we’d spoken about before for the consultation wasn’t available. I googled this person and was very uncomfortable about meeting with her because she’s a member of a small organization that a large number of people I work with are also part of. The connection to my work was way too close.
I articulated this to S.M. and he was insistent that I needed compromise somewhere with my confidentiality concerns. He wants me to meet with someone even if I am worried about their association with my work and then work through those concerns in the therapy. There’s just no way I could feel comfortable enough to even begin therapy with someone so closely associated.

I believe I made the right decision here and feel further reinforced with this by the fact that at my work this week, the organization that that therapist is a part of came up in a meeting. We are inviting this group to an event in the near future. The organization already contains 1 past therapist from several years ago before I began this job. Had I agreed to meet with this new therapist I might have been dodging 2 past therapists at the same event. Hopefully that one therapist won’t attend this event.

S.M. told me that he’d run out of resources and that he would call this therapist if I wanted to meet with her, but otherwise I needed to find a therapist on my own.
I feel horrible. I feel guilty for bothering him so many times about referrals. He’s really gone above and beyond with finding me therapists in the past so it’s not fair to feel angry at him. But I am a bit angry. I was holding myself together with the hope that he’d find me a therapist and it fell apart.
Part of me wanted to call him apologizing for bothering him so much, but I didn’t because I realized the apology would be a little passive aggressive.

I found one last local place to try to call. They didn’t have availability until January. I can’t wait that long. I had a panic attack while on the phone. I was such a mess, that the secretary put me on hold, saying that she’d try to find someone I could talk to right then on the phone. At some point the call was dropped. I tried calling back, but they had closed for the day.

Per the suggestion of some folks here, I decided to expand my search radius. I discovered that Second-Closest-City is easier to get to than I’d realized. It’s actually easier and faster to get to this further away city than to a lot of the suburbs surrounding my city. This city is far enough away that people are not all affiliated with where I work.

I made a lot of phone calls. Nothing was working. I can’t count how many panic attacks I had. I skipped out on a lot of obligations, because I was too upset to leave my apartment.

I was working on my next suicide method and kept calling my Dad crying. He took over the search for me. I hate having my Dad do these things for me. He’s very busy and I am really trying to pretend to be an adult. But I was falling apart trying to manage it myself.

My Dad found someone for me to meet with who was able to see me a few days from then.

On the day of the appointment I traveled to Second-Closest-City. I’ve traveled through Second-Closest-City many times, but I can only think of one time when I was maybe 12 that I actually visited it.
I was very prepared for my trip. I put together a whole packet of maps and train schedules. I decided I would walk, but spent 20 minutes getting lost and progressively more anxious. It’s scary coming to a new City and not even knowing where the main streets are. I asked a stranger if she knew where I could get a cab and she gave me the number of a cab company.
I waited for 10 minutes, no cab arrived. The time of my appointment was rapidly approaching, and I was worried about waiting for a cab that might not ever show up. I backtracked to a more populated part I’d walked through earlier and found a cab.

I really don’t like taking cabs. It goes against the whole don’t get in a car with strangers idea. I know a number of people who’ve been held up by cab drivers and some who cab drivers attempted to rape. I’m a very tiny person, I wouldn’t be able to do much to protect myself.
Also in a strange city sometimes it can be hard to distinguish legitimate cabs from illegitimate ones. This one was particularly shady, but I was desperate. It had a meter which added some legitimacy to it, but it was very run down and the driver gave me the creeps.
I safely made it to the building where the therapist is located. I had traveled 2 hours from the door of my apartment to the door of his office to discover that he has a buzzer at his door.

He directed me to a waiting room, which wasn’t really a waiting room. It’s clearly a room he usually uses for group therapy sessions. The chairs were all arranged in a circle. At first I thought he was going to conduct the individual session in there! There would have been a lot of empty chairs available for the empty chair technique.
The actual office was more typical, although it was meticulously organized. My first impression of him is that he dresses more like a lawyer than a therapist.

He commented on my outfit and asked if I was still dressed for Halloween. I let him know I dress like this year round. A tactless early comment, but I let it slide.

The first session went well enough that I returned again for a second appointment.

The second appointment went less well. My trip to Second-Closest-City was nice. I conveniently was able to take the same train as a friend who commutes daily to Second-Closest-City. This friend is someone who doesn’t know any specifics about my crazy, but I am comfortable enough with that I shared my reason for going to Second-Closest-City with him. I have a lot of trouble justifying social interaction in my schedule. If nothing else this trip can force me to communicate with another human for a bit.
My friend and I shared a cab, because the weather was bad and he was traveling in the same direction.

I arrived at the office with 3 minutes to spare. A big change from my usual 20 minutes early, where I avoid going into the office until at least 10 minutes of.

He was dressed less like a lawyer this time, but I have a serious comment for you folks: Do not wear brown shoes with a black suit. Fashion disasters make me sad.

I brought my collection of neuropsychological testing to the appointment. The therapist had seemed a little uncomfortable about writing my Ritalin prescription and asked if it could wait until this 2nd session. I figured I should bring the testing so he’d know I wasn’t inventing the ADHD diagnosis myself. I’m really worried that my decision to go so far away might be misinterpreted as something drug seeking.
I’ve given many of my therapists copies of my testing. Some are more interested in others. Based on his questioning from the first appointment, (He asked a lot of neurological and general medical history type questions) I thought he’d want to see them.
I don’t have a good way to make copies. I could theoretically do it at school or work, but I don’t feel comfortable copying my personal private information there. So I brought the originals and asked if he was able to make copies.

He said he could make copies there and proceeded to do so. For the next 15 minutes. The copier was misbehaving. He unstapled and restapled all my reports. Papers were put everywhere. I have to check through all my reports now to make sure no pages or entire reports are missing.

It felt very disrespectful of my time. Yes the therapy session is only scheduled for 50 minutes, but I have to carve out 5 hours in my day when including travel time. If I’m waking up at 5:30 in the morning to begin my day so I can fit this in, then I’d like to get the full 50 minutes.

I get that he might want to avoid having tasks for patients outside of the billable hour, but despite his similarities in fashion choices to a lawyer, therapists billable hours don’t usually work the same way. Their fee should partially factor in doing some tasks outside of the session. This is why the hours are 50 minutes rather than 60. Every other therapist who I’ve given reports to has made copies and given the originals back to me the next session, rather that using session time.
It’s possible that he just didn’t realize how much trouble he’d have with the printer, so it took longer than expected. But I found a similar trend in the 5+ minutes spent discussing billing. He mentioned that I’d not brought a check the first session. I hadn’t realized he wanted me to. I thought he was going to bill my Dad. I asked if he could just send my Dad the bill. He wasn’t very into this idea. he really wanted to sort it out right there.
It turns out he takes credit card. I paid with my American express card. American express has a reputation for charging a lot in fees to vendors. I hope he got charged a lot in fees for being too lazy to send my Dad a bill. I get that maybe a lot of patients don’t pay bills promptly, but my Dad is very reliable about these things. I’m not sure if my credit limit can handle getting too many of these charges. I usually just use it to buy food.

It makes me really anxious to see the sticker price of sessions. When I submit it to my insurance company for reimbursement the cost will go down to 15-20 dollars per session, but to see $500 for the two sessions on my receipt makes my heart rate speed up.

This left less than 30 minutes of therapy time.
We had a very uncomfortable interaction where he asked me if I wanted him to help me. He wanted me to say “I want you to help me” rather than me just answering his question with a “Yes”. I didn’t cooperate.
This and a couple of things made him feel more like a bad “self help guru” than a psychiatrist. He listed the 5 things he felt were important in a psychotherapy session and the 3 types of communication he believes exist. It felt trite and cheap and tacky.

The session was very directed towards talking about my childhood. I certainly do believe that my childhood had a role in the types of problems I have today, but he doesn’t even know yet what most of my problems today are. It’s too easy for this type of therapy to turn into time where I just say horrible things about my parents. And my parents (especially my Mom) definitely messed up in some places, but they were well intentioned. I did not appreciate his efforts to make me express anger about my Dad for a situation where my Dad really had no good options. He’s paying the bill! and basically is a good guy aside from his inability to be emotionally supportive.
I mentioned that I am not going home on Thanksgiving and the therapist reacted much too enthusiastically about this. He hardly knows my situation and reacted as if I was cutting ties from an abusive family situation. My family is dysfunctional in many ways, but not abusive. My reasons for staying here are more academic than emotional.

I much prefer information about growing up to come out organically in relation to information I share about the present. I am suffering here in the present. Yes the past influences that, but the present matters too. Dwelling on every detail of my childhood is not conducive to changing how to feel today. Really, it just makes me more miserable.
Is it unfair for me to seek out a psychodynamic therapist and criticize him for wanting to talk about my childhood too much? I don’t think so. I think a therapy can be dynamically informed while having a present focus.

I mentioned how I’m not fond of the pure free association type of therapy and I prefer when it’s more interactive. He said that he agreed and said that he’d once been in therapy with a classical Freudian-type and had hated that style. I am kind of uncomfortable with that self-disclosure, even though I realize it’s very typical for analytically oriented therapists to have had their own therapy at some point. It felt like over sharing.

When working on the billing, he asked what ICD code I wanted. I’ve been asked in the past what diagnosis others have used for the bill, because they want to be sure I get reimbursed, but never flat out asked which code I wanted. I opted for Major depression, recurrent, moderate, because I’ve had that used a lot in the past.

I’ve been trying to do work on the train, so I don’t feel the time is wasted, but unfortunately I’ve been so tired, that I’ve not been very productive. Maybe as it becomes more routine it will be easier.

I’ve been having a lot of reactions to the idea of going to Second-Closest-City for therapy. When I was calling places looking for a therapist, they’d ask where I coming from and I’d tell them and as soon as they wondered why I’d come so far, I’d start crying. I’d hardly be able to speak.
I feels like it’s some kind of punishment for being so crazy. I’m so messed up I can’t even find a therapist in a city filled with therapists. 3 of my former therapists are within a 5 block radius of my home.
I’m mostly keeping these trips private, people would think it’d strange for me to go to this Second-Closest-City for a couple of hours only. I feel like I’m going on these secret adventures that I can’t tell anyone about.

Some of my professors commute from Second-Closest-City to my city. I have a slight fear that because I am taking such an early train that I might run into them at the train station in Second-Closest-City. I’m not sure how I would explain seeing them there, then seeing them in class later that day. It’s close enough for a commute, but far enough that people don’t usually just stop in for the morning.

There are some upsides though. If I were to be hospitalized, I’d be hospitalized there and my confidentiality would be safer than it could be in any hospitals around here.
I also feel like in this other city, I am suddenly free from a lot of my worries about privacy. I’m in this city where hardly anyone knows me. It’s liberating.

I have some serious doubts that #26 is going to work out. I’ll give it one more appointment to see if things improve, but otherwise I’ll move on. If nothing else I’ve learned that Second-Closest-City is a viable option for finding therapy.