CBT therapist

I’m not going to apologize for my lack of posting, because I hate reading those.

After firing therapist number 23, I thought I might take a break from therapy for a bit. I was very angry at him, but leaving was a huge relief and immediately had a positive impact on my mood. The relief lasted a bit, but soon, without another outlet, some grumpyness began to ooze into my professional life.

I really like psychodynamic theories. The therapist who I have liked the most was psychodynamically oriented, while the one who kicked me out of school was into CBT.

I keep seeking out these psychodynamic therapists in an effort to replicate the therapy I had with this other therapist (S.M.). I want this idealized perfect therapy that I read about in text books. I want one where there are insightful interpretations and the new relationship disproves the assumptions from my old object relations.

My best and worst ideas are impulses that come to me while trying to sleep or taking a shower. I lept out of bed to the computer. I needed something completely different.
I searched on the ABCT therapist directory. I would find a CBT therapist.
This was harder than I expected.
Despite living in an area with a relatively high population of therapists, the list was short. Many of the names were names of researchers working at one particular research center. I didn’t want to participate in a study. I’d feel too guilty when I didn’t get better.
I narrowed the list to two choices and went to sleep.

I made a call to one therapist in the morning.

After the call I began rationalizing my impulsive, poorly thought out decision.

“This isn’t real therapy”, I thought. “This is rebound therapy”.
I don’t believe CBT has the ability to ultimately fix my problems, but I thought maybe I should give it another shot
temporarily. After all it is really the B part, behavioral, I object to, the C part, Cognitive, is not so bad. If I could find a person using the right balance of minimal B and mostly C, maybe it could work.

I figured it could be short term and might shove me out of my therapy rut.

Whenever I disagreed with my previous therapist’s interpretations he would argue that maybe the process he was speaking of was unconscious. It was infuriating, when he would pull things out of seemingly nowhere and say this. How can you argue with the unconscious?
At least with CBT I could dodge that.

I made an appointment and began to feel guilty.

I have so much anger towards the CBT therapist who got me kicked out of my school much of which has generalized to the theoretical perspective as a whole. This poor woman would have to be subjected to this. She had no way of knowing what she was getting into. She’d done nothing wrong yet, I’d not even met her, but I was feeling intense rage and fear towards her.

I felt awful about what I would put this poor woman through and decided I needed a peace-offering to begin with.

Where do CBT and I have common ground? We both like data. I keep track of a number of variables in my life.
I decided to print out an excel sheet of the past several months of certain variables, complete with averages at the bottom of each column.
As it turned out, I never showed her the spreadsheet, because the timing was never right.

I built her up in my head as this monster I needed to defend myself against. When I arrived at the first appointment to discover she had only one head and no visible fangs it was a relief. Almost anything she could have done would have been better than my expectations.

Much of the anger dissipated once I entered the waiting room for the first appointment and behind it I was terrified.

She won some points for acknowledging how traumatic the whole getting kicked out of school mess was.

I decided to keep meeting with her.

I never told her where I go to school or where I work. It started to feel silly after awhile, but it was a nice little extra level of safety. She couldn’t use that information to hurt me if she didn’t possess it.

She’s a psychologist, so she can’t prescribe. In the first week of August my Klonopin was going to expire. That date acted as a deadline for when I needed to transition therapy to a psychiatrist or at least find a psychopharmacologist.

Through a misunderstanding, she thought I wanted to end at the end of June. I’d been thinking more like the end of July, but decided to leave it at June.

I went to her looking for CBT and received supportive therapy, not CBT.
That’s not useless, but also not what I’d been looking for.
For all of ABCT’s posturing about empirically supported treatments and manualized therapies, I didn’t see much of that. I shouldn’t really be that surprised that outside of a research setting CBT can mean anything really. Both CBT and Psychodynamic ideas have problems with inconsistencies in their implementation. Finding that specific treatment you want out in the world is not so simple.

I was even willing to fill out worksheets. There was not a single one. I have trouble believing it’s real CBT without a worksheet or two.

She did admit that it wasn’t really CBT.

Maybe getting something other than CBT from a CBT practitioner was all I could really handle. If nothing else it was some exposure therapy to just show up.

I had such a problem during the spring semester in one of my classes. My intellectual feelings about CBT differ from my emotional feelings. Speaking in class I need to be so careful to only speak from my frontal cortex rather than from my amygdala. Too often I’ve allowed bit of emotion to bleed into my words.

Professionally I need to be able to separate the two. More and more I am encountering situations that push my limits with exposure to CBT outside of my own personal therapy.

Villainizing CBT can be too easy when working with psychodynamically oriented therapists. There is a long history of animosity between the two groups. They tend to collude with me in this issue. The difference is that they are objecting to it theoretically (although emotions are certainly there, but they are an effect rather than a cause), while I am objecting to it emotionally and finding intellectual reasons to rationalize that emotional reaction.

I do feel I got some benefit from the therapy, even though it was clear the therapist felt she’d failed me somehow. Most sessions were me spending an hour going through my massive to do list. I was so busy and exhausted that directing therapy towards a goal was way outside of my present abilities.

Just being there with a CBT therapist, the content wasn’t important. What was important was the conflict free relationship with a CBT practitioner. This helped me work through some of the negative transference I’d been experiencing toward her before the first appointment. Really in this way the “CBT” therapy did more for my object relations than a lot of psychodynamic therapy has done.

I’m still messed up, but this feels like a teensy step in a good direction.

I feel embarrassed about going to see a CBT therapist. I called S.M. a couple of times while I was seeing her. I lied saying I wasn’t in therapy. I asked him for a referral for the new therapist I went to see after this CBT therapist. I also did not tell the new therapist who I saw on Thursday. I lied and said I’d been out of therapy entirely for the past couple of months.

Escape and Keeping things seperate

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.

Non-Suicidal Self Injury in the DSM 5

As you likely already know, a draft of the DSM 5 came out Wednesday.
There’s a lot of interesting stuff to look through, but the part I had the biggest reaction to was the addition of Non-Suicidal Self Injury. Funny that this is what interested me, because in general research on self-injury bores me.

My initial reaction was entirely positive, but after some more thought I realized some potential problems. So, here’s a list of pros and cons.

Pros:
Too often people who self injure get stuck with the borderline personality disorder diagnosis who don’t meet the criteria only because they self injure. In the paper explaining the rationale for this addition (It’s a quick read. I recommend skimming through it if you’re at all interested) the authors mention that self injury occurs in many different disorders.

The specific wording in the title differentiates self injury from a suicide attempt. Hopefully this can help to cut down on some of the overreaction from practitioners about self injury.

Cons:
Does self injury really belong as its own disorder? Are there people who self injure on multiple occasions without any other diagnosis? Is there research on this? Seems strange to add a disorder that might only rarely be seen in isolation, increasing problems of co-morbidity.
But I understand that the way the DSM is set up, it has to be its own disorder or nothing at all. Possibly the benefits outweigh the negatives of added co-morbidity.
In the article (page 10-11) the authors justify self-injury as a separate phenomena by mentioning a longitudinal study showing that self injury decreased independent of other symptoms. This study was done only on patients with borderline diagnoses, not sure it is fair to generalize this to other patients especially because this new disorder plays a role to separate self injury away from only borderline personality disorder.

My largest problem is with section B: “The behavior and its consequences cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.
This seems like a benign thing to add. Similar qualifiers are in every disorder.

Here’s the problem: The way it is written right now, I don’t meet the criteria for this disorder. I don’t have impairment or distress from the self injury, but I have a lot of that from the feelings leading up to the self injury.

Seems silly. No one would try to argue with me that what I do is self injury. I’ve even participated in a number of studies researching non-suicidal self injury. Those studies could easily be used to support inclusion of this diagnosis, wouldn’t make sense for their participants to not all qualify.

Instead, I feel section B should be written something like this: “The behavior, its consequences and/or feelings precipitating the behavior cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.”

The current writing reflects an unfortunate trend to treat self-injury as the problem rather than the reasons for self injury. Certainly many people feel guilt over their self injury, but this is not the case with everyone.
The authors touched upon a similar idea in their section, “Placement in the system: A Mood or a Behavior Disorder?” (Pages 8-9). Much of their argument leads towards placing it in mood disorders, with a side note of similarity towards impulse control disorders, so it seems strange for the mood component to be omitted from the impairment part of the diagnostic criteria.

Partial Hospitalization #1

A partial hospital program is sometimes also called a day program. You spend the day at the hospital, but then go home to sleep.

My first partial hospital program was right after my first hospitalization. I lasted two days there.
This is the program that I mentioned in my post about how they sent me someone else’s records.

The social worker in my hospitalization set up the intake at the partial hospital program for me.
I told her two requirements I had for it:
1. It needed to be an adolescent program
2. I did not want to do DBT

When the social worker informed me it was set up, she told me my requirements had been met.

When I arrived on the first day, I quickly learned neither request had been fulfilled.

I realize now that avoiding DBT in this type of program is likely an impossibility, but I’d have appreciated her being upfront with me about this. To be fair she probably didn’t know the program contained DBT. But the reason for this is probably because she didn’t put any effort to find out.

My request for an adolescent program was reasonable. I was 19. My inpatient hospitalization had been with adolescents (their cut off was age 21).

There was a group of about 6 others in the program. I was by far the youngest. Most were old enough to be my parents.
I was very uncomfortable. I listened to people complain about their children and spouses. I couldn’t relate.

At my intake meeting a ‘No Harm Contract’ was presented.
‘No way’, I said ‘I will self injure if I want to and forcing me to sign that just will force me to lie. I’d rather not need to lie.’
The contract was pushed aside to be reevaluated in the future.
I left that meeting with the understanding that I had in no way suggested I would refrain from self-injuring.

I was very angry and aggressive (verbally, not physically). Largely because I was stuck at this partial hospital program because I’d been kicked out of school and possibly also in a small part because of a bad reaction I was having to Celexa.

I was under the impression that successful completion of this program was necessary to help my return to school. Despite despising the program, I felt I needed to stick it out.

The first day was a Friday. That weekend I returned to the school to move everything out of my dorm room.
Most was removed Saturday. Sunday morning I came to retrieve the last few items and discovered another person sleeping in what had been my bed and a large bong in the bathroom.

Monday I returned to the partial hospital program. The first day I had left my sharp items at home. I wasn’t sure what I was getting into (would my items be searched?) and decided it was in my best interests to leave them at home. Monday, the second day, I came prepared with a swiss army knife in my pocket. This seemed fine based on my experience the first day.

Inpatient hospitalizations are under-structured. Too much time with nothing to do. Partial hospital programs are over-structured. One group after another. Spending the entire day dwelling on problems, because the structure prevents one from going out and doing anything enjoyable.

I was frustrated with the way the people leading the groups spoke down to us, as if the depression meant we were cognitively challenged.

During the lunch break I made a few little tiny cuts on my leg. Very minimal, close to zero blood draw.

In the afternoon I had a daily check-in meeting with a social worker. As a side note I mentioned cutting a little during lunch. I didn’t think it was a big deal to mention. I’d never agreed to the no harm contract.

I was transported into an office with another woman (someone with a higher level of authority). She demanded to see what I’d used. I handed over the knife.
A lecture proceeded in a disgusted tone, wondering how I could have possibly thought it was acceptable to bring a “weapon” (aka a small swiss army knife) into a hospital.

She demanded to see the cuts.
I refused, explaining they were minimal and did not need medical attention.
She argued that because I had done it “on the premises” she had to see them.
I continued to refuse.
“I’d have to take off my pants to show you”, I protested.
She seemed unconcerned.
I was scared and eventually intimidated into giving in.
I tried rolling up the pant leg to show the cuts, but as I’d suspected the leg wouldn’t push up far enough.
I unzipped, pulled down my pants and showed her the cuts.
I felt very violated.

“Well there’s not too much damage this time“, she huffed.

That was it. The last straw. I announced I was leaving the program.

She bombarded me with questions assessing my current suicidal risk, trying to trick me into saying something to allow them to keep me there.
I didn’t fall for it.

My knife was returned and I went home.

I still didn’t have a therapist. While making phone calls to find one, many therapists refused to see me on the basis that I’d not properly completed the partial hospital program. I only was able to get into therapy (although this was my fake therapy, because anything I said was at risk of being reported back to my school) eventually when I left out the bit about the incomplete partial program.

Confidentiality Struggles on Inpatient Psych Units

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.

Hidden Self-Injury Tools

I should preface this post by mentioning that I don’t feel self-injury is inherently bad, it can be helpful so I find efforts of others to prevent me from doing it frustrating. You might with to read my other post about self injury first.

When I began self-injuring I also began hiding tools to accomplish it. This way I would always have access should I feel the need. Safety pins were hidden in most articles of my clothing. I had a pencil case filled with razor blades and bloody gauze.

In my first hospitalization I secretly brought in a safety pin. A small item I impulsively decided to hide when I realized what was happening. Turned out this was unnecessary.

They did an awful job of searching my things. When my searched bag was handed to me the first thing I did was open a compartment and pull out a brand new razor blade. My roommate had packed the bag and handed it to my parents. The razor blade had been left in the bag previously.

To make it seem I was healthier than I was I promptly handed the razor to the mental health worker who had given me the bag. My manipulation was wasted. This interaction was never entered into my records and I don’t believe he told anyone because it was him who had missed the blade in the search.
Upon later inspection I realized all of my buttons (the kind with little sayings on them and pins on the back) had been left on my bag. I had accumulated a very large assortment of sharp items.

Initially I had decided I would respect the rules of the hospital and not self injure while there, but after a series of frustrations with the hospital I decided there was no reason for that.
I scratched up my arm a bit one day. Hardly any damage, it’s tough to do much with a pin. I didn’t hide it but also didn’t show it off. It was noticed and I handed over some of the pins.
A threat was made, “Is this everything? We can search all your things again if you want”
“Search if you want too”, I said
I made good eye contact. They bought my pretend confidence.
Later, feeling manipulative again I walked to the nurses station with a pin and said, “Here, I found this in my room”
The nurse made a big fuss about how proud of me she was, not knowing I still had my original safety pin. This was entered in my notes.
I scratched a bit at times following and was not caught.

In the weeks preceding my second hospitalization I knew I was feeling unstable. I had destructive plans running through my head with no specific time set.
In the event that I needed to be hospitalized I decided I should ensure I would have materials to self-injure with in the hospital. I hid razor blades in many items that are always on my person.
Sure enough when I was rushed to the ER I had a nice assortment of sharp new blades. None were found during the search. No one expects the lengths I went to conceal them.
I had quite the stash of blades. I cut a lot during that hospitalization and was not caught.
The closest I came was when I was cutting and punching a wall in the shower. The wall punching made more noise than I anticipated and nurses came barging into the bathroom. Fortunately through feigned modesty and angling my body in ways to hide the cuts, I was able to get enough privacy to get clothing on without being caught. I admitted to the wall punching but the cutting and razor blade were not discovered.

On the day I was being discharged, minutes before I left, I passed a clean new blade to a friend I’d met there. She’d mentioned wanting to cut and being friendly I decided to help her out. It’s a fuzzy moral area for me. It’s one thing for me to cut. I know I won’t go too deep, but other people are uncontrolled variables.
Later I heard she cut up her arm pretty badly and was discovered. She wouldn’t give up my name though when the psychiatrist was demanding the information from her.

At my third hospitalization I also arrived well armed with razor blades. The ER room I sat in had a spare unused blood draw kit. I was bored with making balloons out of latex gloves so I took it and hid it for later.
An accomplishment I shouldn’t be proud of but am is that during this hospitalization I cut in the shower while on one to one security. Meaning, I had a person who’s sole job was to babysit me and make sure I didn’t do these sorts of things and still managed to not get caught.
I tried to draw blood with the blood kit. I thought it would be neat to try and bleed until I passed out. I was doing it wrong. It didn’t work. I tried calling a friend with a history of heroin abuse (the same one who I gave the blade to the previous hospitalization) I thought maybe she would have advice regarding sticking a needle in an arm. She didn’t answer the phone.
I later learned those kits are set up to only work when the blood tube is attached. I didn’t have any tubes.

I was trying to express to the doctors how not okay I was. I gave them useless the blood kit and some of the razors that had become rusty from the shower. I wanted them to know what I’d been up to. It didn’t work. I was discharged the next day despite still being very suicidal. First thing I did upon arriving home was OD on a bunch of pills.

Having so many sharp things hidden in my possession makes airplane travel very stressful. I’m fine with sneaking sharps into a hospital, but not fine with sneaking them onto a plane. The consequences of being caught in the hospital are very low, but being caught with it at an airport is serious business. Before a trip I have to carefully comb through every single possible hiding spot and remove the blades. There are so many I don’t remember them all. I’m incredibly anxious while going through security. I worry if i missed one.
To make matters worse I nearly always have my bag searched additionally. I travel with at least three cameras on the average trip, along with assorted other electronic devices. No matter how I pack these items, my bag appears suspicious under X-ray.
Fortunately it appears I’ve never accidentally left a razor blade behind in my bag, but it continues to be a source of worry every time.

If you are someone who works at a hospital I hope you don’t take out of this post that security needs to be drastically upped for everyone. I think a better message is that if a person wants to do something badly enough they will find a way to do it. Also it is important to note, that most of the in hospital self injury I did was directly following attempts to reach out to staff for help verbally that were unsuccessful.

Research Participant

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Outgoing Introvert

The other day one of my professors described me as ‘outgoing’.

I consider myself very introverted. On the surface the two terms might seem contradictory, but I think together they describe me accurately; despite Definr listing ‘outgoing’ as a synonym of ‘extroverted’.

I view being introverted as having a lower need/threshold for social interaction than extroverts. It is a separate trait from social skills, being socially anxious or talkative.

I can understand why my professor would think of me as outgoing. I talk a lot in class. Probably to the point where it’s annoying to classmates. In the moment I don’t appear anxious. I beat myself up after about everything I said awkwardly when I get home, but in class all is good. I am smiley, bubbly and engaging.

What she doesn’t know is that the talking I do in class is the majority of the social interaction I have in an average day. Most people consider class to be disruptive to their social life, for me it is my highlight.

I like to think that I give the impression of having a lot of close friends, that all the acquaintances I interact with think I have many close friends; I just happen to not be as close with them in particular. I think I succeed fairly well at this. I am on good superficial terms with a lot of people, it gives the impression of greater friendships than I really have.

I do enjoy social interaction, it just wears me out a lot. I can’t keep it up for as long. I need to be by myself to recharge and organize thoughts. I love how college is broken up into pieces. I don’t usually have things planed straight through 9-5. Usually I am able to head home in between classes.  I believe this recharge time is one of many factors explaining my improved academic performance in college compared with high school.

Sitting in a room quietly with a person next to me consumes more energy than sitting in the same room alone. I don’t know if this is how everyone feels, but I know having a lower amount of social energy to use makes this type of energy expenditure more signifigant.

After a long chunk of social interaction I badly need to be by myself. Living with my parents, many fights between my Mom and I occurred from her inability to respect this need of mine. Usually this resulted in me screaming to be left alone, while she persisted with asking questions about how the day had been. She knows, I hope at least, that given an hour or so alone I’d be up for talking, I just needed my recovery time.

I don’t mean to give the impression I don’t get lonely. That’s not true. I do. Sometimes. Usually I’m not. Quitting therapy initially created loneliness. Losing 2 hours a week of talking was a very significant dent. I was able to make some adjustments in my schedule to fix the problem.

I also don’t mean to give the impression that social anxiety isn’t a factor at all for me. It plays a role, a more minor one, but a role nonetheless. I just believe that it is a separate trait from introversion. My problem is more anxiety in general and some happens to fall into the realm of social anxiety.

The most important thing for avoiding social anxiety for me is structure. I need a clearly defined role. In class I don’t feel anxious speaking. I’m expected to be there and to speak, my participation grade depends on it. In a job requiring interacting with people it’s the same way. I know what I should be doing and have no problem doing it.

On the other hand, If I spot an acquaintance in the cafeteria I’ll likely smile and say ‘hi’, but I won’t join him/her unless directly invited. I’d worry I was invading their space. The role is less clearly defined.

I like the internet, because it allows for controlled social interaction. If I need a break all I need is to go to a new webpage.

Being a secret introvert can be useful in comparison to being a non-secret introvert. I feel my mental health problems are less likely to be suspected. The loner image is generally not positively viewed and makes one open to suspicion.

I’ve always been introverted, but there are life events that have added to my isolation. Having friends over to my house was a stressful experience. It wasn’t so bad in elementary school, but in middle school problems began with the way my Mom would behave when I had visitors. The details are for another post, but long story short, in early high school I decided it wasn’t worth it to have friends over. I had a lot of people I socialized with I school, but the majority of the friendships (there were some exceptions) were superficial. I feel like this caused me to miss out on some of the typical experience of gaining closer friends.

My experience of getting kicked out of school for mental health reasons also contributed. In the over two years since that happened I’ve become significantly more withdrawn. I feel terrified of the situation repeating itself and hide much more than I hid prior to it. Directly following that situation I had my trust in a couple of friends shattered. My ability to trust has been badly damaged. I hate it. I want the limits I have with social interaction to be only from my introversion, not because of my paranoia.

I made a friend recentlly. It’s exciting. I like her a lot and we share many interests. But there’s a limit for how close I have ever let her get. We may get to the point where it seems to her like it is not a superficial friendship, but for me there will always be a limit of what I can share.

My outside doesn’t match my inside.

Whoops, I got a little off the introversion track at the end there and more into trust issues, oh well. I’m sure you can deal with that.

General life update stuff:
-I finally called my old therapist who is awesome and made an appointment. He was totally fine with me meeting with him, even for only the summer. It’s a relief.
– I got into an honors psychology society thingy. Yay.

Psychology Scams

A handful of times I’ve learned of acquaintances falling for psychological diagnostic scams. The most notable are a urine test telling neurotransmitter deficiency and a brain scan to diagnose a mood disorder (Amen Clinic).

I can understand wanting a definitive diagnosis. I know how frustrating it is to go from doctor to doctor with a new diagnosis each time.
When hearing of these two scams, my initial reaction was skepticism and interest. Why had I never heard of them before? Why had no one ever recommended them for me? Quick searches for more information revealed why I’d not heard of these tests.

Neurotransmitter levels in urine do not necessarily reflect the amount of the neurotransmitter in the brain.

We don’t know enough to use brain scans for diagnosis of most psychiatric problems. There are a lot of studies finding differences between the brains of healthy controls and people with a specific problem, but a lot more research needs to be done to use it diagnostically.

Of course there are things that can be diagnosed with brain scans, which makes the Amen Clinic’s service seem legitimate. We can spot brain tumors for one. I even have a friend who had his schizophrenia diagnosis confirmed with an MRI. It’s important to realize that he would have still been diagnosed with schizophrenia regardless of what the the MRI scan showed, it just provided additional evidence for the diagnosis. Also, schizophrenia is a disorder with a larger body of MRI research.

We are no where near being ready to look at a persons brain and tell them they are bipolar.

Unfortunately one of my friends doesn’t realize this and shelled out a lot of money (looks like $3,375.00. according to the website) for this procedure. This clinic also takes a general history. I’m betting that’s where the bipolar diagnosis came from, not the overpriced photos of her brain.

If someone has a lot of money they don’t mind wasting they should go into the two different locations and tell different fake symptoms and then leave with two different diagnoses.

I wonder if the people running these know the science is shoddy? Maybe one person at the top knows and the underlings follow blindly.

If I thought these tests worked I’d get them done in a heartbeat. I want concrete answers. I want to know what is wrong and exactly how to fix it. The guesswork is exasperating. It’s unfortunate that this desire gets taken advantage of.

The people I know who bought into these scams to do not know the tests are bogus. They were given diagnoses and a recommended drug. What do I do? Do I educate them? Or maybe the damage is done and I should leave them be?
They were told in fancy sounding terms what FDA approved drug to take. The treatment plans they were told were nothing dangerous. It’s possible they are getting placebo benefit from this. I’d hate to ruin it if it’s helping them.

But, what if the drug isn’t the right fit? Are they going to feel trapped into taking it when alternatives might be preferable? Or feel hopeless/un-fixable if it doesn’t work?

I also have concern about them advocating the test to others. They share in common this enthusiasm about the test, thinking they’ve uncovered this secret hidden away by the medical community. Should they be told, so others are not dragged into this?

I’ve decided to mind my own business, but I feel a level of guilt over it. As a not-very-close-friend I feel saying more would cross a line.
I wonder how a therapist would/should handle a patient who begins therapy armed with this false information. It’s going to be hard to form a therapeutic alliance by shooting it down at the start. But if the information doesn’t fit with the best treatment plan then something needs to be done.

What do you think? Have you heard of other similar scams?