Why do I go through so many therapists?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It would have been nice to end on a multiple of 5

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.

Imagining Self-Injury and Therapy

I think about self-injury a lot. Most days I don’t self-injure, but most days I think about self-injuring.

In the earlier days of my self-injury the thought would pop into my head and in most cases I would do it as soon as I could following the idea.

I didn’t care about getting blood on my clothes and often wore dark pants that would hide the blood stains.

I wanted to self-injure and then it was off to the nearest bathroom. That’s an exaggeration. I still thought of self-injury more than I acted on it, but I acted on it much more quickly when I did. Certainly external events would sometimes prevent me from doing it, but I’d often find ways, even if it meant secretly scratching myself with a safety-pin under my clothing.

That was high school. Things shifted in college.

It’s obviously more comfortable to self-injure in my bathroom than in a public one. In high school waiting until I got home meant waiting until the end of the day. In college, waiting until I got home often meant waiting however long it would take me travel there. Sometimes that means waiting until a class is over, but rarely the long waits I would have in high school.

I began opting to wait a bit to have the better self-injury experience at home rather than the scared “I hope I don’t get caught” one in a public bathroom. I don’t always do this. I still punch trees, sign posts and walls while walking places, but those days are more extreme than most.

This waiting has stretched out more and more. When before it was waiting 3 hours for a class to end, now I’ll wait the whole work day. Almost all of my self-injury now occurs at night. Self-injury at night is routine, but in the day time is a sign of trouble.

The freedom is crucial. It’s not that anyone is telling me I can’t self-injure then. I can do it if I want to, but often opt to instead wait for the preferred environment.

I picture the self-injury in my head. Imagining the cuts on my body. Sometimes I move a finger briskly across the location I will cut. I think of watching the blood drip down my leg.

And these images in my head are soothing. I plan, “I’ll self-injure when I get home”. Knowing that option and plan is there helps.

I fully intend in the moment to self-injure when I arrive home. But often by the time I arrive at home, my mind is on to other things. Sometimes I self-injure and others I don’t. The intention is the same when the initial thought arrives, but the intervening experiences vary, leading to different outcomes.

I want to be sure to differentiate what I am talking about from therapy techniques where a therapist authoritatively tells a client that they should stop self injuring by trying to wait X amount of time and then revisit the idea.
This is a process that has evolved on its own rather than being artificially forced upon me.

I am not waiting as a means of ultimately avoiding self-injury. As I have said, I don’t think self-injury in moderation is objectionable.
But do I prefer to bleed through a pair of pajama bottoms rather than a nice pair of pants? Yes.
Do I like looking down at my leg throughout the day to be sure blood isn’t visible to people? Not really.

In the moment, I believe with a high degree of certainty that I will self-injure when I arrive at home.
It just turns out that I am not very good at predicting this.

I recently had an occasion where I was concerned I might need to change clothing in front of another person. I wasn’t sure and it turned out not to be the case, but I was very worried about it at the time.
If no fresh cuts are visible I can angle my body so that scars might not be seen.
I had to avoid self-injuring for a few days after I learned of this event. I go weeks without self-injuring fairly regularly. I thought a few days would be nothing.

Once I told myself I couldn’t self-injure my stress skyrocketed. I couldn’t visualize the self-injury. It only worked when I believed in the moment that I would do it for real when I was home. The images were nothing without the hope of reality.

I’d not been fully aware how often the thoughts were in my head. As soon as you try not to do something it becomes so much worse.

The thoughts themselves are soothing. I need the possibility to be open.
I can’t force any of this. It only works if the thoughts are spontaneous.

I was able to avoid self-injuring, but it was not an enjoyable few days.

I’ve found a similar phenomenon occurs with my therapy.
When I am in therapy I have frequent conversations in my head with my therapist. All the conversations are ones I imagine I could have with the therapist. Often they are difficult topics I’m struggling to bring up and I replay the scene over and over looking for the right way to present information.
My actual therapy sessions only vaguely resemble their imagined versions. Some topics from my visualizations do get brought up in my real therapy, but most do not.
The pretend therapy in my head is a useful tool for sorting out thoughts and often by the time I get to therapy I don’t need to talk about that issue any longer.

When I am not in therapy this process doesn’t work. I have to be able to think the conversation could take place. Without it my brain becomes a cluttered mess.

When in therapy that doesn’t seem to help much in session, the pretend therapist in my head that I gain access to can be more valuable than the session itself.

Without therapy I sometimes shift to imagined blogging, which is not as good as imagined therapy, but serves a similar function.

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.

It won’t go away

The 3 year anniversary of when I was kicked out of school is a bit over a month away.
It’s been so much, time but it is still an incredibly touchy subject.

I can speak about suicide, self-injury, hair pulling etc in a detached, emotionless voice. When talking about my forced medical leave I struggle to get out a sentence at a time without being interrupted by crying. When upset, my verbal ability plummets.

I spoke with a researcher who is studying people who have been forced out of their school or asked to leave due to mental health issues. I’m glad someone is working to get awareness for the issue. I don’t feel I did a good job of communicating the long term difficulties I have as a result of the forced leave, but at least I did something.

School is the most important thing to me. As you can see from this blog’s name my major is a important part of my identity. Before this mess I was a different major. I defined myself by that major too. I’ve lost a part of who I am. That old identity is tainted by these happenings. I try to push that old part of my identity away and people keep throwing it back at me.

I feel so isolated about it. There are support groups for so many things. Except this one thing I could really use a support group for. I need not only someone in the same situation, but someone who also has long term problems from it.

There’s a message board I’ve been going to for support of a more general nature for nearly 5 years. Using a message board for support is tough. I spend so much time trying to give background information that I don’t feel the ability to vent freely that I really need. What I really need is a best friend and I use the Internet as a poor substitute. My most recent thread, several weeks ago, related to ways this still impacts my life. I felt very misunderstood. Feeling misunderstood feels like an attack. I tried to put on a strong front in my replies, while alternating between tearful keystrokes and slicing open my leg. I wanted to clarify and understand how I can better explain myself. I am extremely touchy about this issue.
I don’t need people to tell me to move on from it. I know I’ve been hanging onto this a long amount of time. It’s easy to tell a person to get over it and not understand why the issue is still hanging around.

Let’s look at this through Compromise Formation Theory which admittedly I don’t know a ton about, but the little I know leads me to feel it is particularly applicable here. I wouldn’t be doing something if it didn’t provide some benefit.

The negative part of this compromise is that I am still hanging onto this thing that happened nearly 3 years ago and have incredible emotional sensitivity to it.

On the other hand, hanging on to this issue is the only way I know how to feel some security. Letting it go feels like opening myself up to the possibility of it happening again. I would be too vulnerable.

My hyper-vigilance is both damaging and protective.

Periodically I do a very stupid thing and google the therapist who got me kicked out.
He’s developing quite the web presence or so he appears to think.
Up until recently, he thought it was a good idea, and not at all reminiscent of tacky 1990s websites, to include a hit counter on his blog.
I’ve taken a lot of pleasure in knowing how small his web audience is.
Yes, it’s petty, but it helps me.

In my more recent googling I learned he is publishing a book, set to come out this year.
It has a cutesy name, the same as his blog, and is about taking a trendy psychology concept and adapting it for
a young urbanite audience.
A blog I can deal with, a book is a different issue. It has the ability to reach a large audience. The thought of all these people reading his book and possibly thinking he is a great guy upsets me.
I wish I were brave enough to publicly tell everything, write my own book, so people could know the rest of the story about him.

I have these horrible images in my head of spotting his book in one of my professor’s offices. I need to keep my old world separate from my new one. A book on the wrong bookshelf would signify an invasion. The fear is almost as bad as if it were to really happen.

In reaction to this I did the only thing I could. I used my Internet knowledge for a tiny piece of vengeance, while not violating any laws.
I reported his domains to ICANN. He had blatantly false Whois info (I highly doubt his phone number is (999) 999-9999).
I got one of his domains suspended for a few days.
Again, petty, I know, but it put a smile on my face for a little bit.

I wonder if he knows I did it. Probably not.

I’m sure I’m much less on his mind than he is on mine. This is part of the problem. It hurts to see him achieving any level of success, when I still have a day to day struggle over what he did.

Within the past week, a blog post of his was featured on the front page of a highly trafficked pop-psychology website. I wonder how many people I know read his article, having no clue about our association.

I want to scream out to the world ‘Hey look what he did!’, but I can’t because what he did left me too scared.

The Therapist List

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

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

I have an appointment with number 21 for Tuesday.

Here’s the list:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

29. Current Therapist