Dear W.P.




Dear W.P. (aka. The student suing Princeton following a forced medical leave),

Best of luck with your case. I relate a lot to things written in your lawsuit. I especially relate to the idea of living in constant anxiety trying to comply with the readmission requirements. I also can relate a lot to the issue of the campus counseling center betraying confidentiality and contacting non-health professional school officials. It was terrifying to realize how imperfect confidentiality is.

About the gap in your academic record. I was really worried about that, but no one has ever noticed or questioned it.

I hope you win and can help make some changes in the policies at Princeton.

I imagine the lawsuit is a stressful route. I beat myself up periodically for not taking the lawsuit route. The OCR complaint seemed better since it was less aggressive and I wasn’t to stay at the school. But I wonder if I had pursued the lawsuit route if I could have had more of an impact. I hope it works out for you.

Anxiety and the way it sneaks up on you

As anyone who had read anything on this blog knows, I’m an anxious person. There’s not a day that can go by without me feeling anxious. The things is though that most days at this point although my average daily level of anxiety certainly remains in the clinical range the intensity is something that is very manageable.

This lulls me into a false sense of security. I can forget what it feels like when it spikes back up.

Then all of a sudden it will appear unexpectedly. It’s been 8 years since the involuntary leave saga happened. It’s bizarre that cues related to this event can activate panic so intense after so much time has passed. I had a point where anxiety relating to this was generalizing to anything tangentially related to the event. I have made a lot of progress though. There are things that were formerly consistently able to evoke anxiety that now are not anxiety provoking at all.

But there are still things than can make me anxious with thoughts about this event.

Today I was ambushed by anxiety.

Graduate school likes to create situations where students are presented with options but gently and clearly informed that there is one choice they should make. This seems to be the case with practicum selection for next year.  I reviewed the options with my current practicum supervisor and was clearly told which practicum I should apply to. I was told this information in a way that makes me think that if I deviate from this direction that I will likely not get a good recommendation for other options that I pursue for this next year. The bit about the recommendation is likely me making a slightly paranoid leap based on the information. However, I do know it is clear that I do not have the support from my supervisor for pursuing the other option which I had greater interest in.

The problem? The location is a college counseling center.

I had no idea the idea of working at a location like that would make me so anxious until I was presented with a situation that suggests it may be my only option.

My mind leaps to worries about what if I end up in the role of a cog in a big bureaucratic machine and am forced to choose between my job and doing to another student the same thing that was done to me. I have no way of knowing if this school does involuntary leaves. It’s not a thing schools like to advertise.

This is the largest burst of anxiety that I have experienced for awhile.

Then I had a bizarre moment of doing therapy on myself. I have not been doing therapy with clients for long. This is the biggest spike in anxiety I have had since getting into more of a rhythm of doing CBT with clients.

So internal therapist me said: Ok so you are worried that at this practicum you might do to someone else, a thing that was very damaging for you to experience. What would happen if this occurred?

Anxious Me: If I do that to someone, I’ll probably kill myself

Internal Therapist Me: So you’re worried that if this happened you would not be able to cope.

Anxious Me: Yes. Maybe I wouldn’t kill myself, but I would be very dysregulated and probably do something impulsive like maybe an overdose that is unsuccessful like I used to do all the time in high school.

Internal Therapist Me: So is it a 100% chance that this would happen?

Anxious Me: Ok well I guess there is a possibility that it might have other outcomes. Maybe by the time this happened I would be in a better place. But I’m worried about what I would do. Would I secretly let the student know their legal options?

Internal Therapist: Switching this issue to the question of whether you’d advise the student about legal options is a way you are using worry to avoid the catastrophe and the anxiety associated with it. You fear causing the same trauma to happen to someone else or that a similar event will happen again to you and that you will not be able to cope if it occurs. The worry here is not about the little details. The details allow you to cognitively avoid the real feared situation but they maintain the worry.

As I am writing this out for this blog I am thinking……………..

Anxious Me: But I’m still anxious. It’s probably because I’m a lousy therapist and being a lousy therapist is why my supervisor does not want me to apply for the other practicum location.

Internal Therapist: Do you see how this thought might relate to the same core belief? You are saying that you are not a good enough therapist and also that you would not be able to cope. What core belief is this?

Anxious Me: That I’m inadequate.

Internal Therapist Me: Do you have any evidence that does not support the belief?

Anxious Me: I got into this graduate program. I regularly do things that make me anxious rather than avoiding them. I have more publications early in graduate school than many people have when they graduate. But….we know that I have a big history of not coping well at times and having quickly escalating suicidally.

Internal Therapist Me: It’s true that you have had a lot of times where you had trouble coping, but some of the more serious situations were awhile ago. Are there things that have changed that make you better at coping now?

Anxious Me: Yes I’m in a much better place than I have been in the past. I tend to be able to wait longer before acting on destructive impulses. Even though I still self-harm, I am able to limit it only to the evening which generally means that by the time is it the evening often I no longer want to do it.

Internal Therapist Me: So we can’t be certain that if the feared situation occurs that you would be unable to cope.

Anxious Me: Yea maybe I would cope. But it does not matter. If it happened it would be so terrible. I just really don’t want it to happen. Or if it is going to happen I want to know and I want all of the details so I can prepare.

Internal Therapist Me: I can’t promise you that it would not happen. No one can predict the future with complete certainty. Worrying is not preparation. This is a maladaptive belief about worry. It tricks you into thinking you are preparing, but really there is nothing you can do right now impact the possibility that this even might occur.

Anxious Me: I know that intellectually but convincing myself emotionally of it is not an easy task.

Internal Therapist Me: Maybe you need to try some imaginal exposures to the catastrophe?

Anxious Me: No. exposures for worry are dumb and I’m not convinced they work.

Internal Therapist Me: Have you tried them?

Anxious Me: No. But I don’t want to.

Internal Therapist Me: Then how do you know it won’t work?

Anxious Me: Ok I don’t really know for certain but I still don’t want to do it.

Internal Therapist Me: Does thinking about doing them make you anxious?

Anxious Me: Of course. That’s kind of the point of exposures. It’s not an exposure if it’s not anxiety provoking.

Internal Therapist Me: Do you think that it is worth trying then?

Anxious Me: Maybe. But back off on this issue or I’ll pretend fire you and then have to deliberate on whether I can add myself to my list of fired therapists. 

Internal Therapist Me: Ok if not the worry exposures what else might you be able to try?

Anxious Me: I could choose to specifically pursue this practicum. My clinical supervisor isn’t the only influence over where I get placed and my advisor will support me wherever i would like to work. So I really do have a choice in this situation. Now that I know how much it makes me anxious, on some level it feels like i should do the practicum just so I can’t have anything in the back of my head making me think that going elsewhere is an avoidance behavior. If I go there it will chip at another angle of how the worry related to this event spread into a lot of different places.


Ok that’s enough of that. I need ice cream.

The thing about grad school

  • The thing about grad school is that you get stretched so thin that you can’t do your best at anything.
  • The thing about grad school is you are too tired too appreciate how amazing it is to be paid to learn.
  • The thing about grad school is that every day is a question of picking which people to let down today.
  • The thing about grad school is that you don’t have the power to arrange your schedule in the most effective way
  • The thing about grad school is that you can’t read google calendar on the weekly view because there are too many things each day.
  • The thing about grad school is you know you are not operating at your full potential when you make mistakes from being over burdened
  • The thing about grad school is that everyone wants the tasks they assign to you to be your number 1 priority, but it is impossible to have 5+ different number 1 priorities.
  • The thing about grad school is you are too busy to pause to think about aspects of your work you enjoy.
  • The thing about grad school is everyone says they will not give you a task until they think you are able to do it, but somehow you always end up working beyond your skill level.
  • The thing about grad school is you can still get student discounts while also being an instructor of students.
  • The thing about grad school is you care too much about all of the things you under-preform at.
  • The thing about grad school is watching what happens when a bunch of high achieving perfectionists get pushed to their limits
  • The thing about grad school is everyone tells you grades don’t matter but keeping the funding is dependent on your GPA.
  • The thing about grad school is you start to get academic spam mail for bogus conferences.
  • The thing about grad school is you become an author on a paper you don’t even like.
  • The thing about grad school is you identify useful skills you could have acquired in undergrad if only you had known. And now you have no time to learn them.
  • The thing about grad school is you don’t have time to employ the good study skills that helped get you into grad school.
  • The thing about grad school is to survive you have to be more accepting of your mistakes.
  • The thing about grad school is not being able to enjoy things that past-you would have been so excited to do.
  • The thing about grad school is that every day is a roller-coaster of inching towards productivity and failures.
  • The thing about grad school is wondering whether you are coping worse than others.
  • The thing about grad school is wanting to sleep for a year.
  • The thing about grad school is lack of privacy for emotional breakdowns in the lab.
  • The thing about grad school is it’s hard to find a tutor to help when the class content you don’t understand is so specialized.
  • The thing about grad school is you feel invested in helping your undergraduate students and sacrifice sleep to schedule more office hour meetings.
  • The thing about grad school is moving to a new place and only knowing people in your cohort.
  • The thing about grad school is doing the math estimates of when would be best to have a baby.
  • The thing about grad school is fear of letting down your psychotherapy clients
  • The thing about grad school is wanting to stay despite the problems.

Edit March 11th, 2015: Where was this post linked that is causing me to get so much traffic to this page? WordPress says somewhere on Facebook but won’t tell me the exact link. Where are you coming from?

Anything else?

“Have you ever been hospitalized over night for anything?”, the allergist asked. I paused and told him about my appendectomy. “What about for anything else?” he asked. And I responded “No.”

I hate lying. But I didn’t want to open that unrelated can of worms about my three past psychiatric hospitalizations. I am forthcoming about the big picture existence of my mood and anxiety symptoms and any medications I am on. Any doctor I see knows I have anxiety issues, but it’s hard to trust everyone with specifics. With the rise of electronic medical records I get anxious about disclosing more information to be documented in a record system I have less control over. The anxiety a little question like this causes is one of the many ripple effects of my Involuntary Leave Saga. I need to control access to my information in order to keep myself from being vulnerable to misuse by fumbling but maybe well-meaning health care providers.

I have had a rough few weeks. My therapist (still number #29 Mr. sarcastic anonymous commenter) has vanished for the past 3 weeks. He is sick. The absence was unplanned. I have no idea what is wrong or even for certain if he will return next week. I can generate possible worst case situations of what happened faster than I can type them. I was in a downward mood slope before he got sick and have continued to be below my baseline. I am worried about him and feel simultaneously guilty for the truck-load of problems I have been collecting to dump onto him. How can I go in and unleash all that when his past 3 weeks have clearly been much worse?

And this is why I am still terrified every day: More on universities and suicide attempts

I found a post on the Student Doctor forum of a Clinical Psychology graduate student who faced disciplinary action due to a suicide attempt.

This is particularly scary to me because one way I try to help myself stress less about the idea of being outed and facing discrimination from my school is that I like to imagine that as a psychology graduate student I should now be in a position to better advocate for myself because I know more about the system. But the reality is I have zero guarantees that I would be able to protect myself against a bureaucratic system with an agenda. OP in the linked post brings up some good questions in his/her post regarding uncertainty of how this event impacts future applications to things like internship and post-doc.

I was “lucky”(if it’s possible to be lucky in how you are discriminated against) in that my school did not treat my leave as a disciplinary issue, but rather an involuntary medical withdrawal. My transcript has a missing semester. There is zero sign that i was withdrawn from classes that semester after the drop date. One of my graduate applications asked about gap in education and I agonized over what I was required to disclose. I settled on a honest minimalist matter of fact single sentence response that did not disclose my mental health history but did disclose that the gap was medical. I worried about whether someone would figure out what the gap meant and lower their opinion of me. It was scary to worry that one sentence I had to report over an act of discrimination from several years prior might impact my career.

The after effects of discriminatory actions schools take against student are tough to navigate. I have talked in this blog a lot about the emotional after effects my forced medical withdrawal had on me, but OP in the linked post also raises a lot of good questions about concrete issues to navigate about possibly being forced to disclose about the event on future applications.

Every time I see that this type of thing has happened to someone else I feel a terrible mush of anxiety and anger and sadness. I feel so powerless when I see it continue after this much time has passed. People like me have filed OCR complaints and won, but for every school that changes it’s policy in a positive way another 10 seems to change the policy in ways that punish treatment seeking.


Other posts on this topic from my blog can be found here:


Search Terms Answered #6

This post is part of a series where I respond to questions that have brought people from google to this blog which the blog does not answer well at present.


Today someone found the blog by searching:

“therapist tells me her problems. is this part of the therapy?”

Dear Google Searcher,

This not not something that should be a part of a good therapy relationship. Therapists are allowed to self disclose at times but it is something that much be done very carefully and rarely and only in ways that prioritize patient interests. If it feels like your therapists is using you for support in some way this is a giant red flag. Part of what makes therapy unique from a friendship is that the focus of attention should be on the patient rather than the bi-directional type of focus seen in friendships. If something does not feel right in your therapy remember that you can always get a consult with another clinician for a new perspective.

It still happens: Involuntary Medical Leaves in Higher Education

Here is a post by a young woman who was put on an involuntary leave similar to what I went through about 7 years ago.

She does a much more eloquent job of explaining it than me. She also tells the story without a pseudonym and shares it with her school community. I really hope the best for her and that she is able to enact change.

A lot of why the involuntary leave has continued to haunt me so much is due to the terror it induced in me about the risk of it happening again. It created this giant ripple effect in my life with the measures I take to avoid letting it happen.

I hope that maybe for her, being open about the experience rather than hiding will minimize the long term damage. For me, I just can’t take the risk. Maybe 40 years from now if I get tenure somewhere and have loads of funding I’ll do a Marsha Linehan or Scott Barry Kaufman style reveal, but right now I will stay in hiding.

Maybe when I returned to the school that kicked me out I should have shared it with everyone. Perhaps I would have been better off if I had told everyone exactly what happened. Maybe also moved off campus to remove the school’s power over my living arrangements. Maybe I would be long over it if I have done that. I don’t know. All I know is that in this present moment it feels unsafe to share.

It’s a terrible situation that hiding is what makes it worse but not hiding could mean losing my ability to pursue my goals. I have no doubt that if I were not exerting so much effort to hide parts of myself my symptoms would be considerably lower. This is what mental health stigma does. It takes a bad situation and makes it worse. The vast majority of my therapy in some way or another always gets back to my belief (which was elevated to core belief status from the event) that if people know me fully I will lose things I care about.

I wish so strongly that someone somewhere would be able to create greater awareness for students of their rights in these situations. It’s clear that schools will continue to do this even though the government rules against the schools when complaints are filed through appropriate channels.

As much as I know that ruminating over the past is not constructive I wish I had known what my rights and options were at the time. I knew it felt unjust, but I didn’t know the right details. I didn’t know that I should have been provided information about appeal procedures. I didn’t know the specific laws that were being violated and which resources could help me. I think if at the time had known more about my rights that a quick call from a lawyer could have stopped the entire process.

I feel like the reason this persists is that at the time it occurs people are so vulnerable. I wasn’t clearheaded enough to do research on what to do. The hospital only even allowed me internet access for brief period each day. I didn’t have access to resources to look up my rights even if I had been capable of doing that research. My parents were well intentioned advocates who did their best to fight to keep me in the school, but their approach involved meeting with people who ignored their input. For all of my difficulties in my relationship with my mom, one of her highest priorities is to protect her kids. Her perseveration on topics, which often infuriates me, has at many times protected me when it has come to fighting battles to help me (For example I would probably never have gotten access to special education in 1st grade to help with my reading delay without her advocating). But persistance is useless when none of us knew what to do.

When it happened to me I was so taken my surprise. I didn’t see it coming. I didn’t even know it was something possible. It’s hard to fight a system while simultaneously fumbling to learn the rules. The decision to kick me out happened so fast. I think it was over less than 3 days.

One fear of mine is that I might someday get caught is a situation that could force me to do this same thing to someone else. At some point I will see patients of my own. I will be starting off with undergraduate students at my school. I have no idea of whether this is something done here, but given the high prevalence of schools making these decisions it is probable my school might do this same thing. As a PhD student I would be powerless to stop it. I’d be a cog in the system. More and more I start worrying not just about having this happen to me but what if I am forced to do this to someone else? I have more power to enact change from within a system but right now I don’t have any of the power yet.

It is terrible that this problem has not improved over the past 7 years and its occurrence is still not more common knowledge. People can’t have outrage about situations no one knows about. As long as higher education institutions continue to enact this process in relative obscurity, fostered by the shame victims of the procedure feel, I worry that this will continue to harm more and more people.

Please share this young woman’s post on whatever social media you use. She has done an excellent job of explaining the emotional consequences of these discriminatory procedures and I hope that increasing awareness can long term provide more tools to fight back.