The problem when therapists bring their emotions into therapy: Firing #28

I wrote in my last post about my plan for therapist #28. That I planed to ask her to do med management and that I would see someone else for therapy. Although this was my plan I went into my session with the willingness to be open to making therapy with her work if at all possible. So I didn’t mention this plan right away in my session this week.

I’ve been so desperate to avoid restarting the therapist firing cycle I went through as an undergraduate where I went through 16 therapists in 4 years. I moved here and started seeing #28. I was incredibly determined to make this work. If anyone had asked me what my main goal in therapy was I would have said that my goal was to not fire my therapist. Unfortunately I think this determination allowed me to stick around in therapy that was detrimental to my well being and stability.

My therapist firing cycle was part of a reaction to bad therapy. Bad therapy scares me so much that I have been inclined to leave at early signs of problems. With #28 I was so focused on avoiding the awful cycle of firing therapists (fire therapist -> relief -> panic -> new therapist) that I partially lost sight of the adaptive parts of this process. I didn’t see the red flags for what they were.

With #28 the problem was in 2 phases. The first phase was before school started. I wasn’t feeling any desire to talk to her about things. I didn’t feel any attachment. I was feeling like we had no therapeutic alliance. It wasn’t bad other than that it was not good. Then with school starting my stress increased and I brought more emotionally charged issues into therapy. The problem of a lack of a therapeutic relationship became dramatically highlighted. #28 made interpretation comments, but outside the context of a safe supportive relationship these comments just felt critical and unempathetic which furthered the problem of lack of alliance.

But I was determined to make this work. I tried to explain what I explained above. I tried to point out examples of these problems as they happened. The problem is that #28 ended up taking my comments personally. It wasn’t obvious right away that this was what was happening.

I was making comments about behaviors that were making me perceive her actions as unempathetic and she interpreted that as a judgement against her. Read that sentence again. Doesn’t that feel backwards?

The problem is when a therapist brings their emotions into therapy it fall outside of the pattern therapy is expected to follow. She was trying to interpret my comments about her as part of my pathology. I know myself well enough to know that it didn’t fully ring true. But at the same time I could see that she was activating things I am touchy about and see some truth in it.

A big source of my conflict with my mom is that she takes my problems and makes them into her own problem to the point where I have to put my emotions aside and deal with hers. So when #28 was telling me that ‘most of her other patients think she is very empathetic’ and I tried to explain (without success) that a comment like that is exactly what I am upset about, it makes things very messy. It plants this doubt that maybe I am blowing things out of proportion. Maybe I am imagining slights that are not there. Especially when #28 is trying to make interpretations about my interpretations about her.

I have been in enough therapy to know it’s okay to sometime leave feeling a little more upset. But that also that should not be the norm and therapy should not be making me feel worse about myself as a person. At the same time I was feeling desperate to work things out. I was feeling worse because I desperately wanted to find a way to explain what was wrong and therefore fix the problem to avoid my therapist firing cycle. The problem is that the more I desperately tried to explain, the more #28 took things I said personally.

I went into my last session with her open to trying to resolve it (but with an alternative plan in mind). #28 gave me the push I needed to be clear that the problem was not all in my head. Before telling her about any plans to leave, she in a very angry tone and raise voice started scolding me for being too negative and telling me how she felt like I was never going to forgive her for one mistake. I responded that it wasn’t about one mistake it was about how she kept responding to my attempts to discuss the mistake. I’ve never had a therapist be so openly hostile towards me before. It was scary. But it  made me realize that I wasn’t wrong for seeing hostility in the sarcastic comments she had been making in other sessions. #28 even admitted that she was experiencing countertransference. I had been seeing anger leaking out in little ways and when I tried to talk about those angry responses as being unempathetic she had been trying to place the problem onto me.

What makes a therapist bringing their emotions into therapy so damaging is that there are no witnesses. There’s no one I can ask to say, am I overreacting? That should be the therapist’s role, but when the therapist steps far enough out of the role of neutrality I can’t get a fair judgment on my emotional state. I spent the past month on edge, feeling crazier than normal. I’ve been feeling like I went back to emotionally being age 18, like years of progress were erased. And then her reaction became obvious enough that there was no way I could doubt it was happening. Before that though I had to wonder if it was me. Am I too critical? Am I not giving her a chance? Am I overreacting?

#28 refused to meet with me only for medication. She said she does not see people for med management only and that if I even just needed a stop-gap until I find someone else it would need to be on a different day of the week (A day which I spend in class and can not go to therapy). I realize now that this is for the best. But right after the session I spent an hour sobbing in a parking lot down the street from her office as I panicked about the possibility of running out of my ADHD medication.

I had to pull myself together enough for a class at school. I hid myself in a corner before hand and booked an appointment online with the therapist who was the top of my list I selected last weekend. I was able to get an appointment for the following morning.

This post is too long so I won’t go into detail about that but I will say that meeting with this new therapist (#29) made it clear to me how bad things had been with #28.

#29 did all the things he’s supposed to with forming a therapeutic alliance. Even though I know the basic strategies he was using to convey warmth, understanding and empathy they still work and they work really well.

I’m upset with myself that I left myself stay with someone like #28 when it was having such a negative impact on my well being. After all the therapy I’ve been through, it is terrifying to realize I can still miss warning signs like I did. When I talked with #29 I got to talk about some major stressors I have been experiencing in the past month. None of these things had been things I had been able to talk to #28 about because all of our sessions were spent with me trying to explain why I didn’t feel safe talking to her and her doing more things to make me feel less safe talking. With #29 I was alternating between sobbing about things I am upset about and gleeful relief over finally being able to talk about them.

I still need to solve my issue of getting a prescriber because #29 is a PsyD and therefore can not give me medications, but at least I have someone on my side now to help me navigate the situation. I’m very glad I was able to get that appointment with #29 for the day after firing #28 because the anxiety of not knowing if the situation will work out well is unbearable. I’m already feeling myself coming out of the emotional hole I’d been falling into because now I have a little bit of hope.

Privacy when receiving mental health treatment: My tired theme of professional boundaries with a new twist of opening up a little

I’m still dealing with figuring out what to do with my therapy situation. Things with therapist #28 are still not working and I’ve given it beyond what I think is a fair chance. I think I might have generated a working plan, but first a little about stuff that happened in between.

I opened up a little and surprised myself

My academic advisor met with me this week and asked if I was okay. I tried at first to give a vague, ‘there’s a problem but I’m fixing it’ type response but ended up sobbing in her office. I’m shocked with myself about how much I said. In reality I actually provided very little information but it was far more information than I’ve shared with anyone who knows me academically or professionally. I shared that I am having trouble with my new therapist, that I had a confidentiality issue in the past and alluded to a problem of firing therapists and having gone through a lot of therapists. For those who have maybe not read other posts in my blog, that is a giant thing for me to share. I shared nothing about the specifics of my psychopathology, but shared about the extent to which I have received treatment. This is something I don’t talk about with people.

I’m so concerned about keeping personal and professional separate. I realized this was the first time I ever talked to someone who is part of my professional work about this dilemma of treatment vs privacy and boundaries. Of course I’ve talked to my therapists about it, but the issue never quite sinks in properly. They are in my field but not my exact professional context. They also can’t fully understand my concerns about confidentiality because they all think they they personally would never do anything to compromise it. They lose the bigger picture somehow.

Confidentiality and risk

It was helpful to hear my advisor validate that confidentiality breaches are a thing that happen even though people don’t like to talk about it. It makes me realize how much of my therapy (even my good therapy) over the past 6 years has put the problem on me (for my reaction to it) and pushed aside the reality that it is a thing that occurs. It hasn’t necessarily been denied, but it has certainly been sidestepped. Certainly my reaction is excessive, I won’t deny that. But I am also reacting to a real risk, even if my response to that risk is too big. In a way I wonder how much of this sidestepping is a process that makes me feel more like I need to respond dramatically. If everyone else is sidestepping it then it is all on me to protect myself from it since no one else is handling it.

I want to put an example of this into another context. Suppose someone had a snake phobia. Let’s say everyone around this person loves snakes. Some even have pet snakes. Everyone is telling the person with the snake phobia that their reaction is out of proportion with the situation. But some snakes can be dangerous. Not always, but it is a possibility. It might even be hard to distinguish between safe ones and unsafe ones. So this environment might make the person with the phobia even more likely to take excessive measures for safety. On the other hand if people acknowledge risks but instead teach the person how to identify types of snakes and how to handle risky situations should they arise it could create support and provide tools to deal with real risks in a way that is appropriate to the situation.

I had this realization that for all the time I’ve talked about privacy concerns in therapy. No one had ever before talked to me about realistic suggestions to manage real risk. Both of confidentiality and of simple professional boundaries (I can’t be in therapy with a professor who teaches in my program for example). I think everyone has been so scared of introducing more ways for me to avoid risks that no one has helped me assess how to handle the risks that really do exist. Most fears have some kernel of reality behind them. It’s part of how they are maintained. But something about my anxiety being so connected to the process of therapy I think has made people respond to it differently than they might with other types of anxiety.

It was wonderful to share a little about that with someone who is really able to get the context I am working within. And it was nice to get some empathy about how difficult it can be and perspective on an approach I may have been overlooking. She said some things I have heard from other people but those things cary more weight when said by someone who is in my context.

Unexpectedly helpful

The conversation also really highlighted how bad things are with #28. My interaction with my advisor was this beautiful interaction with a mix of validation and goal directed conversation interspersed with appropriate humor and joking.  On some level I feel very guilty for letting this bleed into my professional life. My advisor is a therapist but not my therapist. But she basically did far more to help me in 15-20 minutes that my actual therapist has done in the past month. The conversation made me think about some things in new ways and reflecting on it has helped me generate some new possible solutions to me problem.

I need to make sure I keep our professional boundaries in place, but it’s good to know that I maybe don’t need to be as scared if the mask of normality I hide behind slips a little sometimes in her presence.

The new plan

It’s taken several days for some of the conversation with my advisor to sink in fully enough to help me generate a new plan. I am not sure if my plan will work. But having a plan is giving me that glimmer of hope that I need.

Something clicked for me last night after searching for hours for a psychiatrist and not finding anyone who met my criteria.  I finally came up with a plan. My plan (which may not work at all) is PsyDs and maybe social workers. To those of you who have said this to me a millions times, I’m sorry for not giving it much weight. My conversation with my advisor shifted my perspective a bit which made me feel like this is more of an option than I had considered before. I am going to ask #28 to do med management. I really do not like her, but I can suck it up and tolerate her for a once a month meeting for a script. The key to my plan is her going along with this. If she does not then it falls apart. Assuming she cooperates, I have made a list of 3 possible therapists (1 psyd and 2 social workers) who seem like they could work out. I know it seems like a simple, maybe obvious solution, but I had been so stuck on psychiatrists.

I wrote a paragraph here trying to explain why I had been so stuck with psychiatrists, but it was very convoluted and overgeneralized a lot of professional degrees unfairly so I deleted it. It was really my rationalizations for something else. The simplest shortest answer is I have been trying to replicate my relationship with SM (a psychiatrist) and have been stuck on this idea that it will be more likely to occur with other psychiatrists.

My process of therapist searching

Trying to find a new therapist is a scary process. This is separate from pure professional concerns as it also includes the general vulnerability of sharing so much with someone new and the power they wield to hurt me. The process of finding one is difficult. The databases to search just do not have the information needed. Some of this is basic information (like populations served) but also there is the issue of personality match. There is nothing that can estimate if the therapist will be a good personality match. Can someone make an okcupid alternative for therapists? Have the therapists respond to questions about their therapy style, theoretical orientation and populations treated. Then clients can anonymously fill out a survey on symptoms, need in a therapy relationship and desired course of action. Then get a list of match percentages.

No one would ever want the liability. And I suppose most patients don’t know what they want until they’ve seen some who they know are what they don’t want. I can dream though.

Before my decision to branch out to clinicians other than psychiatrists my search was not going well.

I went through the entire psychiatrist data base for my insurance.

I google every therapist before considering seeing them.

Things that make me feel uncomfortable seeing someone or indicate other problems:

  • At least 2 had their license suspended in the past and reinstated. One of whom the reason for suspension was very scary and google searches indicated that this person has some really distorted body image issues (think professional photo on websites being scarily over-photoshopped). Obviously will skip those ones.

My insurance does not let me search by anything other than location and ability to prescribe. This is a problem because it means wading through tons of people who are not options because I am not the type of person they work with. This is a common problem with insurance. They make their list look bigger because they don’t give specific search terms. Also anyone who had multiple offices got listed multiple times. For some academics this meant being listed as many as 5 times because each title they had somehow generated them an extra entry in the database.

  • A ton of the list was of people who only meet with children
  • A bunch of people upon google searches clearly only handle one type of problem (e.g. Sleep)

Then we get into reviews on doctor sites. I don’t weigh the ones that are just numbers highly. Like 3/5 stars is meaningless to me. But the sites that have comments can have important and scary information. I obviously take comments with a grain of salt, but there are different types of negative comments out there.

  • If a lot of people have billing disputes that says something about the doctor’s priorities
  • I use those comments more to identify problems than identify strengths because I am wary of astroturfing
  • If the complaint seems very convoluted or is an ethics complaint that somehow was not made to an official ethics board I am skeptical of it unless there seems to be a pattern or evidence

I look on linkedin

  • How many degrees away is this person from me? I’ve decided that 3rd degree is okay (so many people are 3rd degree connections I would rule out almost everyone). But 2nd degree connection is too close.
  • For 3rd degree connections the people who know people who know the clinician also give me some information about the clinician and their connection to me. If it’s through a lot of academics that makes me more nervous. But if it’s through some of my non-researcher connections that’s less of an issue.
  • I can also estimate their theoretical orientation is they are a 3rd degree connection based on which people I know who are connected to someone they know.

I look on their website if they have one

  • I read any new patient forms they have and any policy forms. I found a ton of people with very hard nosed policies listed on their websites. Things like fees to fill out forms. That’s their first impression to new patients. I understand wanting to make the context clear but there’s a balance. Your website is your first impression. Yes people should be informed of your policies. But if your entire first impression is telling people rules and financial penalties for breaking them this makes me concerned about what it is like to interact with you. I have never no-showed an appointment (I had 2 travel related issues but these were largely outside of my control. In 11 years of therapy 2 missed appointments is pretty good) intentionally. Even if I am unhappy with the therapy I at least show up to the appointment. I don’t do any less than 24 hours cancelations. But when I see extensively detailed policies (I’m talking pages) about missed sessions it puts me on edge. Even though it is not a thing I will do, it concerns me about what this says about the therapist as a person. It makes the therapist look inflexible and cold.
  • I also find it very scary when there are detailed history forms to fill out before the first session. Some history forms can be useful I think, but there’s a line and it concerns me when the quantity of information I’d be asked to provide on a form before even meeting the person is too high. Basic demographics, presenting problem, medications, history of hospitalization, past diagnoses, fine. But there is a point where it is asking too much.
  • I’m noticing a new trend of younger therapist’s having social media policies on their website. I really like this a lot. It makes the boundaries clear and shows that the therapist is adapting to the changing world. The good ones I’ve seen explain what the therapist will and won’t do along with the reasons for it. I also like when the state that they will not look up their clients online unless it is due to an immediate safety concern. Things like this need to be spelled out and can be done in a way that is not authoritarian.

I look at the context of where the person is working. Big medical centers make me nervous.

  • This is where the line between my realistic worrys and unrealistic ones is blurry.
  • I don’t like the idea of going to therapy in a place using EMRs. I want my therapy notes and session dates on paper in a locked file cabinet. If they go on a computer I don’t want the database linked in a way that makes it part of a larger medical record. So, a private practice clinician could use a full disk encrypted computer for notes and records and I would be okay with that as long as it isn’t merged into another database. EMRs are great for some things, like saving me the trouble of needing to know when my last tetnus shot was because an ER doc already has it in the record. But with therapy is can mean things from bad therapy could stick with me even after that therapy has terminated. A diagnosis, a misunderstanding. It can follow me.
  • Going to a session at a big medical center means more people to walk past. I have a greater chance of running into someone unexpected who would then figure out I am there for therapy.
  • I do not know what my future practicum sites will be but it is fair to say any big medical centers might be on the table. I don’t want to feel uncomfortable applying somewhere in the future because of this.

Smaller therapy organizations that emphasize multidisciplinary teams also make me nervous.

  • I know that this is code for the fact that they will regularly review cases with each other and this is confirmed in privacy notice paperwork about who get’s access to what.
  • This means that in going to a place like that, instead of just sharing my information with one therapist I am agreeing to share my information with the whole practice. It may be 6 people or so, but it means losing control over my information.

I search through my gmail for the person’s name.

  • I make sure I don’t have any indication that this person is too closely connected with my work.

I check academic and professional affiliations

  • If they have an academic title at my school this is a problem. I am moving towards being more flexible if they only teach areas far removed from me, but it’s still hard to predict.
  • If they work closely with faculty at my school but do not work there this is also a problem

Through these criteria every single psychiatrist on my insurance list was ruled out.

Now that I’ve opened my search to non-psychiatrists I have options to pick from. So feeling more hopeful. But I guess I wanted to share my search process. I have this odd situation where if I had a patient (don’t have those yet) who needed a referral, I could easily generate a list of good clinicians who I know professionally. But for myself I struggle because all of these great clinicians I know are not options for me because I know them in a professional context.

I’d be curious to see how other people search for therapists. Feel free to share in the comments.

Fear of cycle

I don’t think I can come up with words to describe how terrifying it is to me to not feel like I have a stable therapist situation. I don’t want to go back to my cycle of firing a therapist every few months but I also don’t want to be hospitalized. When therapy is unstable, the risk of me doing something impulsive that gets me hospitalized becomes much higher.

I wrote in my last post about #28 https://psychologytales.com/2013/09/16/lay-off-with-the-psychoeducation-28/

I feel like I’m taking a million emotional steps backwards.

I did about the best job imaginable explaining to #28 where the problems are in therapy with her. But still nothing has happened to give me even a tiny glimmer of hope that it could work out. To make matters worse we have to skip a week. So I have another week of being a mess and terrified about my complete lack of any support. I can’t stand the uncertainty about if this will work out.

I am too busy to have time to be this much of an emotional mess.

I think I would feel better if I had a referral I could hand on to to know it’s a option if nothing works. I literally can not find a single psychiatrist on google in my area who is not affiliated with my training program. I don’t know if I even have any other options at all, let alone one who will be a good match.

Growing, Imposter Syndrome, and Starting Grad school

Long time without an update. I have been feeling like it’s worth making a post about where I am at now. I don’t think I’ll resume regular posting, but I’ve been thinking a lot recently about how glad I am that I wrote a lot of this stuff out here. I’ve looked back on old posts and can see that my feelings have evolved, but I like that I can access information about where I was at that point in my life. Since in the not far off future I will begin seeing patients of my own, I want to be sure that in my integration into the field as a professional that I don’t forget the vulnerability that comes with being a patient in therapy.

This isn’t to say I am recovered from my mental health difficulties. But I can see now that there are places where I have shifted to slightly more moderate perspectives. For example I now feel the need to ad more qualifiers to my feeling that in moderation, “There is nothing wrong with self injury”. More, now I feel that for me personally the risk benefit/ratio makes it such that it is not an area I feel is worth prioritizing for my treatment. That said, I have considerably decreased the frequency I do it at. But this has been more of an incidental benefit from improvement in other emotional issues. Also, I got a cat. Getting a cat has probably done more to decrease my self-harm than any therapy. For example today on my way home I was visualizing how I would cut as soon as I got in the door. But I walked in and my cat demanded my attention. So I hugged him and now I’m writing this blog post. Maybe I’ll cut later or maybe I won’t. It is hard to say.

I also am trying to be more open to DBT as a treatment. Not for me. But I need to recognize that it does help some people. I am going to make a specific effort to receive training in administering DBT. It’s not easy. Looking at the Marsha Linehan book on my desk makes my heart race. But if I can separate the emotions I feel about being bullied by DBT therapists and pull out the useful bits from that by identifying areas to be more sensitive about, maybe the negative experiences with DBT could make me more effective at administering DBT. That said, I don’t think DBT will ever be my favorite treatment modality, but I can recognize that some people find it helpful.

I’m also making as specific effort to not avoid things due to worries that they may increase the chances of my running into the therapist who kicked me out of my undergrad school. I’m not specifically trying to find events where I might run into him (that would be stalking), but if I am invited to attend an event and am debating whether I should attend, I am making an effort to not factor running into him into my decision. For example I was invited to a wonderful talk by my advisor that was put on my a small organization the therapist-who-kicked me-out-of-school helped to found. I was terrified he would be there, but also knew that the event could be beneficial professionally so I went. He wasn’t there. I’ve no gone to quite a few events where I was terrified of running into him and attended without problem. I’ve really enjoyed going to these events and am glad that I didn’t let the worry hold me back.

Even though a lot of time has passed the fear of being somehow unmasked and losing things I have worked for is still very strong. In my research assistant job I took prior to coming to grad school, those fears started to lessen over time. I reached a point where I felt I was contributing valuable enough efforts to the team that the discovery would not dimmish my hard work. But the fear never fully went away. It’s hard when the fear is partially grounded in reality. There is a risk that if my mental health history were known it would impact me professionally. The problem for me is that my fears are out of proportion and I end up hiding even more than is needed at the expense of forming close relationships. Part of what terrified me about dating is that during a breakup the ex could use information they have learned about me to sabotage my career. It has been  roughly 6 years now where I have been unable to form new close friendships. I rely only on the superficial friendships and the people I knew from before it happened.

Some of this maps onto Imposter Syndrome which is very common in graduate students but I feel that my experience is a step beyond what is typical. For the most part in the past with work and undergrad this feeling was limited to hiding my mental health history, but since starting grad school (I’m not even a month in) I feel like it has slammed me in the face. I’m surrounded by so many smart hard working people in my classes. Everyone has such great ideas and asks such clever questions. I am feeling very intimidated. I always tend to beat myself up mentally a bit about things I say, but the current intensity in highly elevated. I worry about not talking enough but then worry about talking too much and if I said stupid things. My anxiety is not usually as social evaluation focused, but this too is unusually increased. I feel like the most awkward one there. I normally don’t care much about the risk of being socially left out but now I’m terrified that I will somehow be ostracized from my cohort if I do something stupid. And then my general distrust comes in because I can’t tell if I am being invited to things because it would be odd to leave out an invite to one member of the cohort or if I am really wanted. Even caring about if I am wanted is a bit unusual for me. I am usually so independent. Things have just started so I imagine that the intensity I am experiencing these things at won’t be sustained, but I am worried that the intense emotions I am feeling will isolate me from my classmates in a way that can’t be repaired over time.

I had to move to go to grad school. I had to leave meeting with SM (the one therapist I made a good connection with). When I resumed meeting with him 2 years ago I tried to tell myself that it might be possible for me to not need therapy after the 2 years. That was not a realistic goal. So I am now meeting with therapist #28. The area I have moved to has a lower therapist per square mile density than I have had in the past. When I also factor in how many of the therapists in the area might be people I will encounter in my academic training I simply can not afford to go back into my cycle of firing a therapist every couple of months. There are just not enough therapists around form me to do that. So I am trying very hard to stick with #28. If I leave, I need to have a very good reason and need to try to not do it impulsively. This is tough because I feel that every therapist I have left I have had a good reason to leave and that it was well thought out. I know there’s no way for me to go through 28 therapists without me contributing something to the problem, but on an individual therapist level it is very hard to see it as anything other than a problem with one particular therapist.

I have only had a couple of appointments with #28 so far. It’s so frustrating to start over and so hard to gauge if things will work. Having a therapist like SM who saw me over a period of 6 years (although with large gaps of seeing other therapists during that time when I was living too far away from him) and knows the history and associations I have with different things and how some of my views have shifted is so valuable. In talking with #28 about some of the social anxiety I am experiencing I get so frustrated needing to interrupt my flow to throw in background information. I am trying with 28, but I don’t feel connected to her. Everything feels forced and unnatural.

She made a comment that freaked me out a lot. If she knew more about me she’d have realized not to say it. Going to avoid the specifics here to avoid identifying myself too much. But the simple issue is that she made an “if ___  then ____” relating to an action she might take if a certain thing turned out to be true. This is an action which would be undesirable to me. She told me this in response to my worrying about whether this thing might be true. It has turned out that the thing I was worried about is not true, but while I was still worried about that I had a new added worry about whether I needed to lie to 28 if it did turn out to be true to avoid her doing the undesirable thing. Sorry that is so convoluted. The simple issue here though is that she created a situation in which my providing her information might hurt me and made me need to consider lying in therapy. I hate lying in therapy. This is one of the things about no-harm contacts and such that infuriate me (that’s not what this was). Rather than help me deal with the situation they create an environment where I feel I can’t be honest which defeats the point of therapy. It’s tough to have an issue like this come up so early. I feel like if I am honest and say that it upset me and stressed me out because I felt like I might need to lie to hide it that she might think I am actually lying about the thing we had talked about before. But if I don’t mention it I get to stew over it and feel like I can’t have open communication. It’s so hard to get things to where I was with SM. If SM had somehow done the same thing I’d feel comfortable telling him and not worry about repercussions of my words. But in this new environment I am worrying that my words will be used against me. This type of problem is the kind of thing that I know is capable of building up into something that causes me to leave therapy.

SM and I are doing brief monthly check in phone calls to ease the transition. I get to talk with him Monday, right before my appointment with 28 so maybe he can help me figure out how to deal with it. The therapy transition is tough. I’ve been having so many new experiences and challenges that I want to be able to talk through with someone. I try to picture in my head talking to #28 about these things and the image and interest in talking fizzles away. But if I think about talking to SM it feels comfortable. Even in my imaginary visualizations of therapy he is better.

I do want to avoid having this end on a negative note. I am incredibly happy with the program I am in. Everything so far has been confirming that I made the right choice with this school. I just need to handle the anxiety enough to get the most out of it.

Worry that is not psychosis

I have a bit of a paranoid streak to my personality. Not something that in itself can be diagnosed, but it impacts how some of my anxiety comes out.

Today I was walking home and a young man asked if I knew the area well. In a city a stranger initiating any contact can be a sign of a scam or other nefarious activity. But many a time I’ve rudely brushed off a lost tourist in error. He stood a little closer to me than was comfortable. We never broke walking pace. I didn’t stop and neither did he. I think he may have brushed briefly against my coat. I gave him directions. I slowed my pace to lose him via slow-walking.

Walking past the police station, should I go in to hide?

He went the wrong way based on my directions. Did he misunderstand or did he never really want directions? If he didn’t want directions what was his motive for talking to me? Is he looping around to follow-me?

I wasn’t pick pocketed. He didn’t rob me. I’ve long lost site of him, but keep looking back to make sure I’m not being followed. 2 blocks away from my home I step into the entryway of a building and look back and forth. There are people, it’s dark but I think none are him. Did he plant a tracking device on me? Should I not go straight home? I get home and search everything. My bag has many pockets. No tracking device. I have some coins in the pocket on the side of my coat he’d been near. What if a tracking device looks like a coin? What if it is microscopic? What if he followed me and I didn’t see? I toy with the idea of throwing out the bag, just to be safe. What if he was trying some kind of RFID theft? I don’t have anything which could be stolen with RFID readers.

——-

Another incident from over a year ago:

I was late for my bus. I ran towards it, only to realize I had run towards the wrong one and past my own bus. There are two that look similar. Embarrassed, I turned around and walked back towards the people I had just run past, the people who were boarding my actual correct bus.

This isn’t a public transportation bus. It’s a shuttle bus, because my work has multiple locations and buses people between them. The buses are primarily used by employees.  It’s a large organization so I don’t know everyone, but it’s not as anonymous as public transportation.

My heart was pounding. I had to take a seat in the very front, because I was the last on before the bus left. I usually sit more towards the back.

I put on my headphones to listen to my ipod so I could calm myself down. It’s a half hour to one hour bus ride depending upon traffic.

These buses are always eerily quiet. They don’t play music, no one talks. There’s not much engine noise.

My earbud headphones were loud, but not so loud that people could hear them. I had a gap between songs. Everything felt very quiet.

The contrast freaked me out. I wondered, “What if I was thinking too loudly? Could they hear me thinking?”

There are some reasons why this isn’t such an absurd thought. I have a tic-like problem with talking to myself (I have a post in more detail about this) The line between my brain and my mouth gets blurry and I don’t have 100% control. So the idea that my thoughts could come out in a way isn’t that strange. But usually I realize what’s up with the fist syllable out and can take some control. I don’t think it happened without my awareness that it happens at all.

But obviously no one is able to really hear my thoughts.

It started evolving.

No. No one is listening.

But what if?

Maybe it’s not the whole bus, maybe it’s just one person

No no no, no one is listening to your thoughts

I thought really hard to myself Hey you listening! Stop it!

Just in case.

There was a postsecret about this. I was glad to see someone else could identify with this.

The thoughts got more detailed

Yes the whole bus wasn’t listening. It was just this one person, a guy. He was sitting behind me. I couldn’t look back. But he was there listening. I didn’t even know if a guy was back there at all.

Well maybe. Probably not. But I persisted in my demands that he leave my brain. Just in case.

And then I got off the bus and continued my day like nothing had happened. No more thought listening fears.

But now whenever I get on that bus. I have to sit in the back, because sitting in the front freaks me out.

There’s a nagging worry that people might maybe be able to hear my thoughts. But only on this bus and only if they sit behind me. And I’m not sure, it’s just a precaution I’m taking. Just in case.

I felt like I was finally losing it. Going up to the next level of crazy. But no it didn’t count, right? Because I knew it wasn’t real. I was just worrying. Just in case.

—-

I think now that this is less of a psychotic symptom and more a sign of extreme anxiety.

I know my brain is out of control, I struggle to turn it off. But I know it is not real. There is no tracking device and no one is reading my thoughts. The ‘What if’ possibility taunts me. My worry gives too much weight to improbable situations.

Search terms answered #4: “dbt therapy contract legally binding?”

This is part of a series where I answer interesting questions that come up in my search terms, that are not already clearly answered in this blog.

“dbt therapy contract legally binding?”

DBT contracts can vary in content but a year long commitment agreement is a very common component.

Short answer is no. It’s really more of a social contract or a promise. Same applies for any of the “self-harm” or “no-suicide” contracts.
I’m not a lawyer so I can’t speak to all the details of why it would be legally unenforceable. My understanding though is that a breach of (a real) contract is a civil issue, so monetary compensation would be what was at stake if one party broke the contract. Imagine if any other medical professional tried to do something similar. Can you picture an Oncologist telling their patient that Chemo is a really taxing process and they want to be sure of a patient’s commitment before beginning so they need to sign a contract? No. And that Oncologist certainly would not bring a patient to court (seeking monetary damages) for changing treatment options if they decided some other route was a better idea.

Your treatment is your own to control. Provided you are not in some type of court ordered (or inpatient involuntary) treatment you always have the right to refuse to do anything at any time.

I hate these contracts. Whenever people have presented me with them it’s always been them telling me to sign it or not get treatment with them. I feel bullied by it. Especially in the case of something like a contract to stay in therapy, I don’t think it is fair to always assume that leaving the therapy is a symptom of the problem. Some therapies or practitioners are not a good fit for some people.

Here’s my question for you readers: Is there anyone out there who feels a contract in therapy really helped them in the long run? Did it help you stick things out, in an ultimately helpful treatment, at a time when you were having doubts? Or was it coercive and damaging to add guilt about breaking a “contract” into the already difficult decision to change treatment?

Do I need to rethink my feelings about DBT?

I don’t usually post links to other articles here. That’s generally not my style. And judging from the content of this one, it’s probably going to get posted many other places.
I just have to share some of my reactions somewhere.

Here is the article
You may need to make a free NYT account to be able to read it.
tldr version: Marsha Linehan reveals her personal history of self-injury

DBT was not helpful for me. With other therapy types that have not helped I never really felt anger towards the big names that created it. I don’t have strong feelings towards Aaron Beck as a person even though there are some complex emotions going on for me about CBT. Things have been different with Linehan though.

Her name has been all over my experience of the therapy. When I was in DBT I worked in her workbook, which I pursed a copy of. In hospitals when DBT was shoved down my throat I used xeroxes of the same workbook.

After I quit DBT my (non DBT) therapist pressured me to take home DVDs of Linehan’s to watch. If I refused to continue the DBT therapy, she thought maybe the DVDs would help. They just made me angrier. I have pages of typed notes picking apart every detail of those DVDs. Some of them were obnoxious and irrelevant such as my criticisms of the lighting quality. Mostly I just felt that Linehan just didn’t get it. Combined with later viewings of youtube clips of her and videos of her I saw in school, I’ve developed a view of her as cold, mean and out of touch. The cultish language of DBT did nothing either to endear her towards me either. That she could possibly have a personal history of these problems was not something that ever would have occurred to me.

A lot of my anger towards this therapy, that was repeatedly forced upon me, became directed at her. She created this overhyped therapy that no one will believe is ineffective for me.

This article really turns a lot of my feelings upsidedown. I guess she’s not quite as out of touch as I thought. Some of these comments she made that seemed cruel make me think more now that she’s using humor as a way to deal with some fo these things.

I am not going to become a hardcore DBT advocate, but it does make me feel its worth a little more examination. Not so much as a treatment for myself (I’ve long ago ruled out the possibility of it being effective for me and strongly believe anyone who treats any therapy as a panacea is delusional), but in terms of general professional knowledge it could be useful. I still have theoretical objections and think DBT is backwards (behaviors should not be the first issue address with in a therapy, IMHO), but this gives it a little more credibility.

This news is certainly going to take over my therapy session today.

I’m still processing my thoughts about this. I don’t usually like to post here without digesting thoughts more, but I wanted to share while it was still fresh news. Feel free to add your thoughts on the matter.

Edit:
I walked into therapy and said “Hey, did you read the NYT today?”
S.M. replied “I haven’t finished reading it yet, but I bet you want to talk about the Linehan article”
He’s got me figured out.

 

Edit Aug 14, 2018: I see I was linked on metafilter and am getting a lot of traffic from there. Be sure to see my newer post on this topic https://psychologytales.com/2016/10/08/updated-thoughts-on-dbt/