I was going through old photos and found some pictures from around 7 years ago. Apparently back in 2006, I decided to make a self-injurying lego robot. I took pictures of it but am not sure I ever shared them with anyone.
I put the photos under the cut. I don’t believe in trigger warnings, and I think this is more comical/absurd than anything else, but I can respect that some might disagree with me.
I wrote in my last post about my plan for therapist #28. That I planed to ask her to do med management and that I would see someone else for therapy. Although this was my plan I went into my session with the willingness to be open to making therapy with her work if at all possible. So I didn’t mention this plan right away in my session this week.
I’ve been so desperate to avoid restarting the therapist firing cycle I went through as an undergraduate where I went through 16 therapists in 4 years. I moved here and started seeing #28. I was incredibly determined to make this work. If anyone had asked me what my main goal in therapy was I would have said that my goal was to not fire my therapist. Unfortunately I think this determination allowed me to stick around in therapy that was detrimental to my well being and stability.
My therapist firing cycle was part of a reaction to bad therapy. Bad therapy scares me so much that I have been inclined to leave at early signs of problems. With #28 I was so focused on avoiding the awful cycle of firing therapists (fire therapist -> relief -> panic -> new therapist) that I partially lost sight of the adaptive parts of this process. I didn’t see the red flags for what they were.
With #28 the problem was in 2 phases. The first phase was before school started. I wasn’t feeling any desire to talk to her about things. I didn’t feel any attachment. I was feeling like we had no therapeutic alliance. It wasn’t bad other than that it was not good. Then with school starting my stress increased and I brought more emotionally charged issues into therapy. The problem of a lack of a therapeutic relationship became dramatically highlighted. #28 made interpretation comments, but outside the context of a safe supportive relationship these comments just felt critical and unempathetic which furthered the problem of lack of alliance.
But I was determined to make this work. I tried to explain what I explained above. I tried to point out examples of these problems as they happened. The problem is that #28 ended up taking my comments personally. It wasn’t obvious right away that this was what was happening.
I was making comments about behaviors that were making me perceive her actions as unempathetic and she interpreted that as a judgement against her. Read that sentence again. Doesn’t that feel backwards?
The problem is when a therapist brings their emotions into therapy it fall outside of the pattern therapy is expected to follow. She was trying to interpret my comments about her as part of my pathology. I know myself well enough to know that it didn’t fully ring true. But at the same time I could see that she was activating things I am touchy about and see some truth in it.
A big source of my conflict with my mom is that she takes my problems and makes them into her own problem to the point where I have to put my emotions aside and deal with hers. So when #28 was telling me that ‘most of her other patients think she is very empathetic’ and I tried to explain (without success) that a comment like that is exactly what I am upset about, it makes things very messy. It plants this doubt that maybe I am blowing things out of proportion. Maybe I am imagining slights that are not there. Especially when #28 is trying to make interpretations about my interpretations about her.
I have been in enough therapy to know it’s okay to sometime leave feeling a little more upset. But that also that should not be the norm and therapy should not be making me feel worse about myself as a person. At the same time I was feeling desperate to work things out. I was feeling worse because I desperately wanted to find a way to explain what was wrong and therefore fix the problem to avoid my therapist firing cycle. The problem is that the more I desperately tried to explain, the more #28 took things I said personally.
I went into my last session with her open to trying to resolve it (but with an alternative plan in mind). #28 gave me the push I needed to be clear that the problem was not all in my head. Before telling her about any plans to leave, she in a very angry tone and raise voice started scolding me for being too negative and telling me how she felt like I was never going to forgive her for one mistake. I responded that it wasn’t about one mistake it was about how she kept responding to my attempts to discuss the mistake. I’ve never had a therapist be so openly hostile towards me before. It was scary. But it made me realize that I wasn’t wrong for seeing hostility in the sarcastic comments she had been making in other sessions. #28 even admitted that she was experiencing countertransference. I had been seeing anger leaking out in little ways and when I tried to talk about those angry responses as being unempathetic she had been trying to place the problem onto me.
What makes a therapist bringing their emotions into therapy so damaging is that there are no witnesses. There’s no one I can ask to say, am I overreacting? That should be the therapist’s role, but when the therapist steps far enough out of the role of neutrality I can’t get a fair judgment on my emotional state. I spent the past month on edge, feeling crazier than normal. I’ve been feeling like I went back to emotionally being age 18, like years of progress were erased. And then her reaction became obvious enough that there was no way I could doubt it was happening. Before that though I had to wonder if it was me. Am I too critical? Am I not giving her a chance? Am I overreacting?
#28 refused to meet with me only for medication. She said she does not see people for med management only and that if I even just needed a stop-gap until I find someone else it would need to be on a different day of the week (A day which I spend in class and can not go to therapy). I realize now that this is for the best. But right after the session I spent an hour sobbing in a parking lot down the street from her office as I panicked about the possibility of running out of my ADHD medication.
I had to pull myself together enough for a class at school. I hid myself in a corner before hand and booked an appointment online with the therapist who was the top of my list I selected last weekend. I was able to get an appointment for the following morning.
This post is too long so I won’t go into detail about that but I will say that meeting with this new therapist (#29) made it clear to me how bad things had been with #28.
#29 did all the things he’s supposed to with forming a therapeutic alliance. Even though I know the basic strategies he was using to convey warmth, understanding and empathy they still work and they work really well.
I’m upset with myself that I left myself stay with someone like #28 when it was having such a negative impact on my well being. After all the therapy I’ve been through, it is terrifying to realize I can still miss warning signs like I did. When I talked with #29 I got to talk about some major stressors I have been experiencing in the past month. None of these things had been things I had been able to talk to #28 about because all of our sessions were spent with me trying to explain why I didn’t feel safe talking to her and her doing more things to make me feel less safe talking. With #29 I was alternating between sobbing about things I am upset about and gleeful relief over finally being able to talk about them.
I still need to solve my issue of getting a prescriber because #29 is a PsyD and therefore can not give me medications, but at least I have someone on my side now to help me navigate the situation. I’m very glad I was able to get that appointment with #29 for the day after firing #28 because the anxiety of not knowing if the situation will work out well is unbearable. I’m already feeling myself coming out of the emotional hole I’d been falling into because now I have a little bit of hope.
Long time without an update. I have been feeling like it’s worth making a post about where I am at now. I don’t think I’ll resume regular posting, but I’ve been thinking a lot recently about how glad I am that I wrote a lot of this stuff out here. I’ve looked back on old posts and can see that my feelings have evolved, but I like that I can access information about where I was at that point in my life. Since in the not far off future I will begin seeing patients of my own, I want to be sure that in my integration into the field as a professional that I don’t forget the vulnerability that comes with being a patient in therapy.
This isn’t to say I am recovered from my mental health difficulties. But I can see now that there are places where I have shifted to slightly more moderate perspectives. For example I now feel the need to ad more qualifiers to my feeling that in moderation, “There is nothing wrong with self injury”. More, now I feel that for me personally the risk benefit/ratio makes it such that it is not an area I feel is worth prioritizing for my treatment. That said, I have considerably decreased the frequency I do it at. But this has been more of an incidental benefit from improvement in other emotional issues. Also, I got a cat. Getting a cat has probably done more to decrease my self-harm than any therapy. For example today on my way home I was visualizing how I would cut as soon as I got in the door. But I walked in and my cat demanded my attention. So I hugged him and now I’m writing this blog post. Maybe I’ll cut later or maybe I won’t. It is hard to say.
I also am trying to be more open to DBT as a treatment. Not for me. But I need to recognize that it does help some people. I am going to make a specific effort to receive training in administering DBT. It’s not easy. Looking at the Marsha Linehan book on my desk makes my heart race. But if I can separate the emotions I feel about being bullied by DBT therapists and pull out the useful bits from that by identifying areas to be more sensitive about, maybe the negative experiences with DBT could make me more effective at administering DBT. That said, I don’t think DBT will ever be my favorite treatment modality, but I can recognize that some people find it helpful.
I’m also making as specific effort to not avoid things due to worries that they may increase the chances of my running into the therapist who kicked me out of my undergrad school. I’m not specifically trying to find events where I might run into him (that would be stalking), but if I am invited to attend an event and am debating whether I should attend, I am making an effort to not factor running into him into my decision. For example I was invited to a wonderful talk by my advisor that was put on my a small organization the therapist-who-kicked me-out-of-school helped to found. I was terrified he would be there, but also knew that the event could be beneficial professionally so I went. He wasn’t there. I’ve no gone to quite a few events where I was terrified of running into him and attended without problem. I’ve really enjoyed going to these events and am glad that I didn’t let the worry hold me back.
Even though a lot of time has passed the fear of being somehow unmasked and losing things I have worked for is still very strong. In my research assistant job I took prior to coming to grad school, those fears started to lessen over time. I reached a point where I felt I was contributing valuable enough efforts to the team that the discovery would not dimmish my hard work. But the fear never fully went away. It’s hard when the fear is partially grounded in reality. There is a risk that if my mental health history were known it would impact me professionally. The problem for me is that my fears are out of proportion and I end up hiding even more than is needed at the expense of forming close relationships. Part of what terrified me about dating is that during a breakup the ex could use information they have learned about me to sabotage my career. It has been roughly 6 years now where I have been unable to form new close friendships. I rely only on the superficial friendships and the people I knew from before it happened.
Some of this maps onto Imposter Syndrome which is very common in graduate students but I feel that my experience is a step beyond what is typical. For the most part in the past with work and undergrad this feeling was limited to hiding my mental health history, but since starting grad school (I’m not even a month in) I feel like it has slammed me in the face. I’m surrounded by so many smart hard working people in my classes. Everyone has such great ideas and asks such clever questions. I am feeling very intimidated. I always tend to beat myself up mentally a bit about things I say, but the current intensity in highly elevated. I worry about not talking enough but then worry about talking too much and if I said stupid things. My anxiety is not usually as social evaluation focused, but this too is unusually increased. I feel like the most awkward one there. I normally don’t care much about the risk of being socially left out but now I’m terrified that I will somehow be ostracized from my cohort if I do something stupid. And then my general distrust comes in because I can’t tell if I am being invited to things because it would be odd to leave out an invite to one member of the cohort or if I am really wanted. Even caring about if I am wanted is a bit unusual for me. I am usually so independent. Things have just started so I imagine that the intensity I am experiencing these things at won’t be sustained, but I am worried that the intense emotions I am feeling will isolate me from my classmates in a way that can’t be repaired over time.
I had to move to go to grad school. I had to leave meeting with SM (the one therapist I made a good connection with). When I resumed meeting with him 2 years ago I tried to tell myself that it might be possible for me to not need therapy after the 2 years. That was not a realistic goal. So I am now meeting with therapist #28. The area I have moved to has a lower therapist per square mile density than I have had in the past. When I also factor in how many of the therapists in the area might be people I will encounter in my academic training I simply can not afford to go back into my cycle of firing a therapist every couple of months. There are just not enough therapists around form me to do that. So I am trying very hard to stick with #28. If I leave, I need to have a very good reason and need to try to not do it impulsively. This is tough because I feel that every therapist I have left I have had a good reason to leave and that it was well thought out. I know there’s no way for me to go through 28 therapists without me contributing something to the problem, but on an individual therapist level it is very hard to see it as anything other than a problem with one particular therapist.
I have only had a couple of appointments with #28 so far. It’s so frustrating to start over and so hard to gauge if things will work. Having a therapist like SM who saw me over a period of 6 years (although with large gaps of seeing other therapists during that time when I was living too far away from him) and knows the history and associations I have with different things and how some of my views have shifted is so valuable. In talking with #28 about some of the social anxiety I am experiencing I get so frustrated needing to interrupt my flow to throw in background information. I am trying with 28, but I don’t feel connected to her. Everything feels forced and unnatural.
She made a comment that freaked me out a lot. If she knew more about me she’d have realized not to say it. Going to avoid the specifics here to avoid identifying myself too much. But the simple issue is that she made an “if ___ then ____” relating to an action she might take if a certain thing turned out to be true. This is an action which would be undesirable to me. She told me this in response to my worrying about whether this thing might be true. It has turned out that the thing I was worried about is not true, but while I was still worried about that I had a new added worry about whether I needed to lie to 28 if it did turn out to be true to avoid her doing the undesirable thing. Sorry that is so convoluted. The simple issue here though is that she created a situation in which my providing her information might hurt me and made me need to consider lying in therapy. I hate lying in therapy. This is one of the things about no-harm contacts and such that infuriate me (that’s not what this was). Rather than help me deal with the situation they create an environment where I feel I can’t be honest which defeats the point of therapy. It’s tough to have an issue like this come up so early. I feel like if I am honest and say that it upset me and stressed me out because I felt like I might need to lie to hide it that she might think I am actually lying about the thing we had talked about before. But if I don’t mention it I get to stew over it and feel like I can’t have open communication. It’s so hard to get things to where I was with SM. If SM had somehow done the same thing I’d feel comfortable telling him and not worry about repercussions of my words. But in this new environment I am worrying that my words will be used against me. This type of problem is the kind of thing that I know is capable of building up into something that causes me to leave therapy.
SM and I are doing brief monthly check in phone calls to ease the transition. I get to talk with him Monday, right before my appointment with 28 so maybe he can help me figure out how to deal with it. The therapy transition is tough. I’ve been having so many new experiences and challenges that I want to be able to talk through with someone. I try to picture in my head talking to #28 about these things and the image and interest in talking fizzles away. But if I think about talking to SM it feels comfortable. Even in my imaginary visualizations of therapy he is better.
I do want to avoid having this end on a negative note. I am incredibly happy with the program I am in. Everything so far has been confirming that I made the right choice with this school. I just need to handle the anxiety enough to get the most out of it.
I’ve seen more therapists than I have years that I’ve been alive. I started therapy when I was 14.
How am I? Oh well I’m emotionally dysregulated. How are you?
I’ve gone and fired therapist number 25 before I even had a chance to write an entry in here about the start of therapy with him. I met with him for 2 and 1/2 months or so.
Only a handful of sessions in I started to feel really attached to him. It terrified me, because that doesn’t usually happen and was and felt way out of proportion to how little he knew me.
That idealization was crushed shortly after. Because I felt over-attached, I rushed into some tough topics.
I think an important role of a therapist is to keep an eye on the patients level of affect and ensure that it is neither too low or too high. The optimal rage is different for everyone every day. Too low and the therapy is too superficial, but too high and it will be too overwhelming to be therapeutic. The optimal level varies based on how much time remains in the session. As the session nears its end the therapist needs to find the way to bring the affect to a level the patient can manage outside of the container of the therapeutic relationship.
I realize this can often be a difficult task, but he did about as poorly with this as possible. The session ended abruptly, leaving me in a vulnerable emotional state. This left me feeling wary about the therapy, realizing that he and I were very out of sync. I picture this session as a chart where x is time and y is affect. We both started at low affect and his line was straight across with no slope, while mine got higher and higher.
We did talk about this after, but I think he took the wrong message from it. I wanted him to be more aware of when things were escalating too far, while he took this to mean he shouldn’t press certain topics at all.
A couple of weeks ago I wasn’t feeling great. I won’t get into the reasons right now, because retrospectively I’m embarrassed about how trivial they were.
I cut in the bathroom of his building before my appointment. I felt extremely out of control. I bled through my pants leg. I spent the session with my purse held over the blood spot so he wouldn’t see.
Obviously he can’t read my mind (Although once a therapist accused me of wanting him to do that, probably with some justification) but I really resented him for not noticing something. I always keep my purse on the floor rather than holding it. Clearly I wasn’t meeting with Sherlock Holmes for therapy.
He was so focused on convincing me that I shouldn’t feel how I felt, that he didn’t get around to understanding how I felt.
He asked me if I was going to be okay over the weekend and I very unconvincingly said ‘Yes’. He didn’t question it.
That weekend I was not feeling well. I had some oxycodone left over from a medical problem I had over the summer (This is a topic for another post) I took that, some klonopin and some seroquel too.
Unfortunately I only slept for 13 hours as opposed to forever.
This is the first time I’ve ever misused prescription medications like this. I felt incredibly guilty about it. I’ve always only used over the counter medications for overdoses. I feel like doing this is betraying a level of trust between me and the perscribing doctor.
I rationalized this somewhat by not going over the daily limit for the klonopin, and only doing so with the oxycodone, because I care more about the trust between me and my psychiatrist than me and random doctor from the hospital who will never know about this.
With a lot of reluctance, I told therapist number 25 about this, but it took me two sessions to fully get out. At the time when I told him about this I wasn’t feeling suicidal any more. I came early though to that session to plan out my escape routes in case he tried to hospitalize me and I needed to bolt. I tossed a hat and sunglasses and change of clothing in my bag as well.
I brought up the idea during that session that my period may be relevant to some of my more serious mood problems. I’ve brought this up before with therapists. I never really can feel sure. Is it confirmation bias? I don’t have a good way to keep track of if my mood changes around my period. I don’t buy into those mood monthly calendars. All self report measures of mood are highly subjective and because I wouldn’t be blinded to when I have my period I question their validity.
I mentioned feeling conflicted about this due to my identity as a feminist. I don’t really have a fleshed out coherent argument about my feelings with this, just an uncomfortable feeling. Somehow I think that if I say the words feminism and menstruation enough my feelings will be clear to everyone.
The feelings have something to do with the society wanting to view women as overemotional on their periods, the medicalization of a normal process and the validity of PMDD as a diagnosis, but again I’m not good at expressing myself here. I can see both sides of an argument about PMDD.
He seemed confused about why feminism would be relevant to a discussion of PMDD. I can handle disagreement, especially since both sides of the argument are dueling it out in my brain. But I was shocked that he wouldn’t even be aware of the possible relevance of feminism to an issue involving menstruation. He seemed very perplexed and I was horrified.
He did apologize the following session without prompting, but still it was unsettling.
Then to make things even more exciting and wonderful (note the sarcasm) The therapist who kicked me out of school (I need a shorter way to refer to him) was on a major news network promoting his book.
Every bit of publicity feels like he is taunting me.
I sent him 3 angry tweets from my twitter account. This twitter account is public and associated with my real identity (not my real name, but the username I mostly use an also people I know in real like follow me there). Probably not my most brilliant idea ever, but I’m leaving them up. If any person searches for his @replies they will know that at least one person out there is very unhappy with him. They’re vague enough that if a person didn’t know the background they would know I was angry with him, but the reasons would be unclear.
This means he now has access to most of my social networking pages. That’s fine though as I put my best foot forward on those, unlike in this blog.
When I went to therapy to talk about this I was very let down. Awhile ago I made a comment about how klonopin makes me stupid, which it does. The stupidity occurs in varying degrees, but to have any relief from anxiety thoughts rushing around, some of the good smart thoughts are slowed down as well. Sometimes thoughts can even be of both types.
I commented on how I had to stop what I’d been working on (Probably for the better as is it was slightly destructive) when the klonopin kicked in, because I wasn’t able to think well enough. He decided to take this time to argue with me about wither I am on the correct dosage. I have had the dosage fiddled with to the point of adjusting it by increments of 1/4 of the smallest pill size. This is the right dose. I’ve been taking it at this dose for a couple of years. I’m not messing with it. He was convinced that there is some ideal dose where I won’t be anxious or stupid. I don’t believe this is possible, because the two are so intertwined and the impact of the same klonopin dose varies depending on the day.
The comments felt accusatory too. Like he thought I was abusing it, although I have never ever gone over my prescribed limit. In the context of previously telling him about my oxycodone and klonopin adventures I was very sensitive to this sort of comment, because I feel so guilty about it.
He was taking a super ego guilt inducing role. My super ego is super at making me feel guilty already thankyouverymuch.
I told him about something I had thought of doing, but did not do and he took his guilt induction much too far. I can’t write about the details here, but basically he took a thought of mine and turned it into a worst case scenario. I tried to protest, but he kept making it worse and worse. The things he was saying were already fears in my head. I didn’t need him to give them credibility.
I have far worse thoughts in my head that I haven’t told anyone. If he reacts with such a judgmental extreme to something less horrible then there’s no way he can handle the worst of me.
I felt like he was treating me like he thought I was a sociopath. He was playing this role of a conscious for me as if I had none.
If he had even a basic personality conceptualization of me he was working from to base his comments he’d have realized that I am already very skilled at guilt.
I stopped talking. I stared out the window for a bit.
Then, I pulled out my Nintendo DS and resumed the game I’d been playing in the waiting room. Really juvenile, but I don’t care.
My brother called while I was ignoring the therapist. I refused the call, but then he called again and I took it, upping my rudeness level by +10. He just had a quick answer to a question I’d had about the game I was playing.
After about 20 minutes of ignoring the therapist although with the occasional yes or no answer to a question I said “I think I should just leave”. And I did. He asked if I wanted to make another appointment and I said “No”.
There wasn’t anything he could say at the point that could have made me comfortable continuing therapy with him.
I hate myself already, I don’t need a therapist thinking I am awful as well.
I rushed out of the building, worried that I was going to be followed or stopped by security. Psychiatry departments are never placed near an easy exit and I think we all know this is not an accident.
I arrived home and decided to take some ibuprofen. I think the reason I am still alive after all these years is that I am awful at swallowing pills. If I were better at I’d have succeed years ago. I had liquid gel filled capsule type ibuprofen. I decided that if I dumped the liquid out and drank it that might work.
Turns out this is the worst idea ever. I tried opening one up, but it didn’t work well, so I decided to just put it in my mouth and bite it. It was extremely acidic. I ran to the sink to rinse my mouth out to stop the pain. My mouth and throat felt sore after, like I’d been vomiting.
With that method ruined, I gave up to the time being.
It’s a few days later and I’m okayish now. I’m not being very productive with school work. I’ve mostly been sleeping and eating ice cream. I don’t know what I’m going to do about the lack of a therapist situation. I hate starting over again and again.
When I tell people why I switched schools/majors I try to put a happy spin on it. ‘It was purely for academics’, I’ll say.
The reality is that after I returned from my involuntary leave, I did not feel welcome.
I was placed in freshman dorms again and harassed by roommates who’d heard rumors about me and dug through my prescriptions, running google searches. They google diagnosed me with schizophrenia and decided I was out to murder them in their sleep. If they were really so scared of me why did they yell at me so much?
I was only able to take one class in my major, because the prerequisites I needed were not offered that semester. My semester off left me a year behind. I hardly saw the classmates I’d known when I was there before. They’d moved on without me.
I avoided large sections of the campus. I couldn’t go near any of the offices involved in forcing me out. I hid when I spotted people involved.
It was not a welcome return.
I just wanted to pick up where I left off like nothing had ever happened, but it was impossible.
I felt so on edge and unwanted. I needed to escape.
I couldn’t transfer and stay the same major. I couldn’t justify that to myself.
I was enjoying my Intro Psych class and reading a lot of psychology books. I’d thought before it wasn’t an option, but as I learned more I reconsidered.
I told my therapist I was leaving to get an MBA. I refused to talk over my decision in therapy. I didn’t tell him I was switching to psychology. I felt uncomfortable telling a therapist I was going into his field. I justified this lie by telling myself I could get an MBA after I got the psychology degree, but didn’t really believe it.
I hate to make it sound like I don’t love what I’m doing now that I am a psychology major. In retrospect I realize now that I have much more enthusiasm for this than I had for my previous major, but the decision will always be tainted because it was made to escape one thing rather than pursue another.
So I escaped to a new school. Except the escape didn’t work. Changing location wasn’t enough. I can’t escape the fear of it happening again.
No matter how well I do academically I am still at risk of it happening again. My last school didn’t care that I was a good student, this one won’t either. The fear is in my head guiding every action I make.
I see a person who looks like the therapist who kicked me out. I know it’s not him, but what if it were him? What if he showed up at my new school? I run through scenarios of what I would do. I get lost in my thoughts.
It’s like I have two images layered on top of each other. One is reality and one is my fear scenario. The opacity is being adjusted up and down. I see one then I see the other. Volume alternates between the scenes. I can forget that I’m only in my thoughts.
I react as if it is happening. Fisted clenched, heart pounding, tears welling up in my eyes.
It goes until something jolts me back into the real world.
I’ve tried all sorts of reactions in my head. Sometimes I scream at him, sometimes I glare angrily, make sarcastic comments. I sometimes try explaining to someone how much he hurt me and that he needs to leave. Or maybe I quietly make an exit and other times the exit is dramatic.
I also go through scenarios where my new school tries to kick me out. Sure I’m better prepared this time because I know my legal rights, but I’d still have to fight for it. The new school becomes tainted because then they also don’t want me there. All my effort to hide things and I end up in the same situation as the old school.
There’s never a good resolution. In every imaginary situation I dig myself into a deeper mess.
I think part of it is my brain trying to find a way to deal with it. If I had a good solution, should the situation arise, maybe I wouldn’t need to fear it so much.
Another part of it that I realized recently is that part of me wants a confrontation with the therapist who kicked me out. I sent him a much too nice email awhile ago which he ignored. I want to him to see my rage. The damage that his own fear caused me.
Even in my head seeking him out for this is unacceptable. But if he invaded my territory, then I’ve every right to defend it. I could show him my anger without as much guilt.
My favorite professor has a number of things in common with the therapist who kicked me out. I’ve been through many scary stories in my head where it turns out they are friends. The rational part of me had been able to say that this was unrealistic. They have similar research interests and theoretical perspectives, but so do a lot of people who don’t know each other.
This semester has been rough. I have a class with that professor and have learned more about him. Like how he enjoys going to conferences of a organization that once named the therapist who kicked me out as their therapist of the month.
My professor recently mentioned reading a blog and recommended it to me and a few others. It was a blog I’m familiar with. This blog has repeatedly endorsed the blog belonging to the therapist who kicked me out. The therapist’s blog is one of 13 links in a recommended blogs section. That therapist’s blog has a word in it’s title that is my professor’s primary area of research interest. If he were scanning that list of blogs this one would stick out.
It is fairly likely based on this information that my professor has read/reads the blog belonging to that therapist.
This potential merging of parts of my life is terrifying.
A whole new set of fear scenarios has been launched. Even something that might seem as small as my professor mentioning the therapist’s blog is scary. How would I react to it? Am I able to hide my reaction?
What if my anger towards the blog isn’t concealed? What if he puts things together, realizing that that therapist worked at my old school?
It’s possible that the reason that therapist no longer works at my old school is at least in part due to my legal action. What if he talked to people about it, without saying my name? What if he talked to my professor about it. What if then my professor put two and two together and realized it was me who the therapist kicked out?
It’s impossible to escape fully as long as I still live in fear of being kicked out of my new school. Even once I graduate I won’t be safe. It’s not just about being kicked out of school. It’s about stigma.
There’s nothing I can do to keep myself safe from the stigma other than hiding everything. It requires large amounts of mental energy. I have to be several steps ahead of everyone. I can’t say something that would elicit a question that might lead to showing too much.
And ironically the problem causing me the most distress is the anxiety surrounding escaping stigma. If I didn’t have this worry I’d have better mental health, certainly not perfect, but better. Trying to hide my crazy is making me crazier.
I’ve found that during my psychiatric hospitalizations working to maintain my confidentiality has been an issue.
I’ve never been hospitalized for non-psychiatric reasons, so I don’t have a perfect comparison. From observing while visiting family in the hospital I can tell that any hospitalization seems to result in some level of decreased confidentiality. When there’s a shared room it’s near impossible to keep everything private. You might not know details, but there is often at least a vague sense of what your roommate’s problem is. Family members who visit, often speak with the doctor without the presence of the patient, creating a risk that information will be communicated that the patient might have not wanted shared.
At my first hospitalization there was some posturing about confidentiality. Cameras including camera phones were banned and the lack of names on doors was emphasized.
I had a terrifying experience of 24 hours in the ER and was refusing to sign the form to be admitted. I wanted to go to a different hospital, but they wouldn’t let me. I asked if I could maybe see the unit first to see that it wasn’t scary. I was told I couldn’t have a tour because of confidentiality issues. This seemed reasonable. Eventually I gave in a signed the form.
A couple of years later I heard from a friend who was considering going inpatient at a different hospital for medication adjustments. He had been given a tour of the unit he would stay on before making his decision. So it appears this rule is not consistent between hospitals.
It seems the most significant confidentiality difference between general medical hospitalizations and psychiatric ones is that for psychiatric admissions patients are specifically encouraged to interact.
In fact, not interacting with other patients will likely be looked upon as a symptom.
Rather than staying in your room in bed all day there are common areas and group activities.
It might seem like that activity group is purely recreational, designed to break up an otherwise empty day. Wrong! In all of my records there are notes of my behavior during those types of activities.
One form for an arts activity group says simply that I attended and comments, “Very quiet- worked with no discussion with peers”. Never mind that I was focused and enjoying that I was doing. All that mattered as a record for that hour was my silence.
The problem of communicating with other patients is that all of a sudden your hospitalization is no longer just a relationship between you and medical professionals, now others are added into the mix. These others have no ethical responsibility to uphold confidentiality.
I know that sometimes outpatient group therapy groups discuss that what is said there should stay confidential, but I’ve never heard any sort of similar comment discussed in an inpatient setting.
Despite this, I have found the unstructured social time of inpatient settings to be one of the few helpful things I have gotten out of my hospitalizations.
I’m so secretive in general that it’s nice to be able to talk without the fear that I will be judged for my ‘crazy’.
But information besides what I choose to disclose also gets revealed. If I was in my room crying all morning, people know. There’s no hiding it. If I go back to one-on-one security, people know my suicide risk was deemed increased.
Sometimes check-in meetings with psychiatrists were conducted in the hallways where anyone could hear. I’d whisper everything and usually reveal less information as a result.
This makes visitors a very anxiety provoking experience. On the one hand it’s nice to get a visitor, on the other hand those visitors are generally my parents. I don’t tell my parents much of anything. They receive the most vague information possible. I worry about another patient blurting out something private about me in their presence.
At the first hospitalization visitors were let onto the unit and were allowed to all the same places I had access to. So much for that “No Tours” rule.
There was no private place to meet. They could go in my room, but I also had a roommate. I was on edge during all the visits, trying to steer them away from anyone I’d communicated with.
The second and third hospitalizations had rooms where visitors and patients could meet for more privacy. The second still allowed family access to the rest of the unit thus compromising confidentiality of anyone there. What if a visitor ran into someone they knew there besides the one they’d come to see? In a general medical hospitalization the chances of noticing someone you know are much less likely unless you were peeking your head into each room.
The third hospitalization restricted visitors movement more, only allowing them in that one room.
Some point in the middle of my first hospitalization my doctor asked me to list the top things bothering me at the moment. One of the top items on this list was the distress my hair pulling was causing me. I later learned that this had been relayed to my Dad. He didn’t understand why I was stressed about my hair (the part about pulling it out got lost it appears). I can’t imagine how that doctor believed that it was appropriate to share this information with my Dad. I was so visibly upset upon learning this that I worry my Dad held back telling me more he might know to keep me from getting further upset. I have no idea if he was told more.
I believe him when he says that he didn’t try to get information out of the doctor and that this was shared more spontaneously. The hospital only had my permission to talk about about logistics (such as arranging affordable outpatient care) with my Dad but still information gets shared that shouldn’t once a line of communication is opened.
My Mom is banned from speaking to any mental health professional of mine, because she tries to manipulate people into giving her information.
I banned her from visiting at all during my second hospitalization and unfortunately it wasn’t very effective because they kept allowing her on until I started to scream that she wasn’t allowed there.
Family meetings seem to be encouraged, again creating the risk that something will be said that I wanted private.
My third hospitalization was the worst with regards to confidentiality. The central issue became my efforts to protect my privacy.
First they told me they were going to contact my school to let them know I was there. I strongly refused.
Anyone who’s been reading this blog regularly knows that letting my school know about my psychological issues is a touchy subject.
‘But it’s our policy’, they said. ‘We have an agreement with the local schools’
I called my lawyer and they called theirs.
After creating a huge amount of panic and stress for me they backed down realizing they had no leg to stand on.
While this was still being sorted out I noticed some student nurses were visiting the unit. I spotted a name tag. My college’s name was on it.
I fled the room. Had they seen me, had anyone recognized me?
Student nurses from my school came twice a week. No one had thought to mention this to me.
It happened too fast for me to spot any faces. Did I know any of them?
I spent the morning hiding in my room.
“Isn’t their being here putting my confidentiality at risk? I don’t want them to know I’m here. Can’t they leave?”
I go to a small school. People know each other.
No one seemed concerned.
I spoke to the apathetic Human Rights Officer.
I wasn’t allowed to ban them from the unit, but I could ban them from any activities I wanted to attend.
But I couldn’t attend the activities, I couldn’t walk down the hallway to get to the activities room without risking being seen.
The only way to prevent them from knowing I was there was to hide while they were on the unit.
When got out of the hospital I sent an anonymous email to the heads of the nursing department to let them know what had happened.
Here’s the email I sent:
“I am writing to inform you about an issue I had recently relating to the *college* nursing department. I do not believe that anyone at *college* was at fault in this problem, but I hope that by bringing this to your attention perhaps something can be done to fix it.
I am a student at *college* and I was recently a patient on the inpatient psychiatric unit at *hospital*.
My confidentiality is very important to me, as I have previously had my confidentiality broken and suffered discrimination as a result of this. I understand that not everyone will react the same way others have, but because of these problems, keeping my psychological issues separate from my education is very important to me.
One day while on the unit I spotted someone wearing an ID saying ‘*college*’. I bolted from the room to speak with a staff member and learned that a number of nursing students from *college* would be there that morning. The staff knew where I go to school, no one thought to warn me of their arrival. I didn’t want to be seen by them. The staff informed me that they couldn’t be kicked off the unit or restricted to a less central location and that my only option was to hide in my room(or the isolation room) all morning. So I was stuck doing that. The stress of hiding there and the isolation it involved were not things I needed piled on top of the reasons why I was already a patient there.
The staff I spoke with (including the human rights officer) were fairly apathetic towards this problem, citing that they have an agreement with the school to allow the students on the unit. I argued that allowing peers of mine to see that I am there is a breach of my confidentiality because them seeing me there involves receiving information that I don’t want disclosed.
I understand that the students themselves are sworn to confidentiality. (Though from my experience when people break confidentiality it is hard to prove and they end up getting away with it), Were I to run into one of these students in a social or academic situation at *college* the interaction would be colored by their knowledge, knowledge that I didn’t want them to have in the first place.
I feel that as a patient my needs, particularly my rights to privacy, should be taking priority over the educational needs of the nursing students, because there is the option for the school to find an alternate assignment for the students in this sort of situation, but I don’t have the option of being in an alternate psych ward for the morning.
I can’t imagine that I’m the first person to run into this problem. And I understand that having the students not be there when someone from their school is a patient there who objects may not be a reasonable option.
I understand that the teaching hospital is a very successful concept, but that doesn’t mean it can not be improved. The current way that it is being implemented at *hospital* is taking too casual of an attitude towards privacy. I do not know if this experience is representative of other hospitals.
At the very least, if you could help me out by giving me a list of all hospitals where *college* students are on the psychiatric units, I would appreciate it. So I can know to avoid them. Because at this point I feel that if I am in need of inpatient psych care I am unable to get it because I fear a confidentiality violation.
Thank you for taking the time to read this. ”
I now have a note behind my ID in my wallet listing 8 hospitals I can’t go to because my confidentiality would be at risk. Basically I would have to travel fairly far to get to a hospital free of my school’s nursing students. Even further if I wanted to get to a reputable hospital.
I got a couple of more sympathetic, “We’re taking this seriously” emails in reply, but basically the end result is still that I can’t go to those hospitals.
Confidentiality should not need be one of my primary worries when hospitalized, but it has to be because I have to protect myself.
Tales of a Crazy Psychology Major 