An adventure to Second-Closest-City and Therapist #26

Last week S.M. contacted me with a name of a potential therapist. The one we’d spoken about before for the consultation wasn’t available. I googled this person and was very uncomfortable about meeting with her because she’s a member of a small organization that a large number of people I work with are also part of. The connection to my work was way too close.
I articulated this to S.M. and he was insistent that I needed compromise somewhere with my confidentiality concerns. He wants me to meet with someone even if I am worried about their association with my work and then work through those concerns in the therapy. There’s just no way I could feel comfortable enough to even begin therapy with someone so closely associated.

I believe I made the right decision here and feel further reinforced with this by the fact that at my work this week, the organization that that therapist is a part of came up in a meeting. We are inviting this group to an event in the near future. The organization already contains 1 past therapist from several years ago before I began this job. Had I agreed to meet with this new therapist I might have been dodging 2 past therapists at the same event. Hopefully that one therapist won’t attend this event.

S.M. told me that he’d run out of resources and that he would call this therapist if I wanted to meet with her, but otherwise I needed to find a therapist on my own.
I feel horrible. I feel guilty for bothering him so many times about referrals. He’s really gone above and beyond with finding me therapists in the past so it’s not fair to feel angry at him. But I am a bit angry. I was holding myself together with the hope that he’d find me a therapist and it fell apart.
Part of me wanted to call him apologizing for bothering him so much, but I didn’t because I realized the apology would be a little passive aggressive.

I found one last local place to try to call. They didn’t have availability until January. I can’t wait that long. I had a panic attack while on the phone. I was such a mess, that the secretary put me on hold, saying that she’d try to find someone I could talk to right then on the phone. At some point the call was dropped. I tried calling back, but they had closed for the day.

Per the suggestion of some folks here, I decided to expand my search radius. I discovered that Second-Closest-City is easier to get to than I’d realized. It’s actually easier and faster to get to this further away city than to a lot of the suburbs surrounding my city. This city is far enough away that people are not all affiliated with where I work.

I made a lot of phone calls. Nothing was working. I can’t count how many panic attacks I had. I skipped out on a lot of obligations, because I was too upset to leave my apartment.

I was working on my next suicide method and kept calling my Dad crying. He took over the search for me. I hate having my Dad do these things for me. He’s very busy and I am really trying to pretend to be an adult. But I was falling apart trying to manage it myself.

My Dad found someone for me to meet with who was able to see me a few days from then.

On the day of the appointment I traveled to Second-Closest-City. I’ve traveled through Second-Closest-City many times, but I can only think of one time when I was maybe 12 that I actually visited it.
I was very prepared for my trip. I put together a whole packet of maps and train schedules. I decided I would walk, but spent 20 minutes getting lost and progressively more anxious. It’s scary coming to a new City and not even knowing where the main streets are. I asked a stranger if she knew where I could get a cab and she gave me the number of a cab company.
I waited for 10 minutes, no cab arrived. The time of my appointment was rapidly approaching, and I was worried about waiting for a cab that might not ever show up. I backtracked to a more populated part I’d walked through earlier and found a cab.

I really don’t like taking cabs. It goes against the whole don’t get in a car with strangers idea. I know a number of people who’ve been held up by cab drivers and some who cab drivers attempted to rape. I’m a very tiny person, I wouldn’t be able to do much to protect myself.
Also in a strange city sometimes it can be hard to distinguish legitimate cabs from illegitimate ones. This one was particularly shady, but I was desperate. It had a meter which added some legitimacy to it, but it was very run down and the driver gave me the creeps.
I safely made it to the building where the therapist is located. I had traveled 2 hours from the door of my apartment to the door of his office to discover that he has a buzzer at his door.

He directed me to a waiting room, which wasn’t really a waiting room. It’s clearly a room he usually uses for group therapy sessions. The chairs were all arranged in a circle. At first I thought he was going to conduct the individual session in there! There would have been a lot of empty chairs available for the empty chair technique.
The actual office was more typical, although it was meticulously organized. My first impression of him is that he dresses more like a lawyer than a therapist.

He commented on my outfit and asked if I was still dressed for Halloween. I let him know I dress like this year round. A tactless early comment, but I let it slide.

The first session went well enough that I returned again for a second appointment.

The second appointment went less well. My trip to Second-Closest-City was nice. I conveniently was able to take the same train as a friend who commutes daily to Second-Closest-City. This friend is someone who doesn’t know any specifics about my crazy, but I am comfortable enough with that I shared my reason for going to Second-Closest-City with him. I have a lot of trouble justifying social interaction in my schedule. If nothing else this trip can force me to communicate with another human for a bit.
My friend and I shared a cab, because the weather was bad and he was traveling in the same direction.

I arrived at the office with 3 minutes to spare. A big change from my usual 20 minutes early, where I avoid going into the office until at least 10 minutes of.

He was dressed less like a lawyer this time, but I have a serious comment for you folks: Do not wear brown shoes with a black suit. Fashion disasters make me sad.

I brought my collection of neuropsychological testing to the appointment. The therapist had seemed a little uncomfortable about writing my Ritalin prescription and asked if it could wait until this 2nd session. I figured I should bring the testing so he’d know I wasn’t inventing the ADHD diagnosis myself. I’m really worried that my decision to go so far away might be misinterpreted as something drug seeking.
I’ve given many of my therapists copies of my testing. Some are more interested in others. Based on his questioning from the first appointment, (He asked a lot of neurological and general medical history type questions) I thought he’d want to see them.
I don’t have a good way to make copies. I could theoretically do it at school or work, but I don’t feel comfortable copying my personal private information there. So I brought the originals and asked if he was able to make copies.

He said he could make copies there and proceeded to do so. For the next 15 minutes. The copier was misbehaving. He unstapled and restapled all my reports. Papers were put everywhere. I have to check through all my reports now to make sure no pages or entire reports are missing.

It felt very disrespectful of my time. Yes the therapy session is only scheduled for 50 minutes, but I have to carve out 5 hours in my day when including travel time. If I’m waking up at 5:30 in the morning to begin my day so I can fit this in, then I’d like to get the full 50 minutes.

I get that he might want to avoid having tasks for patients outside of the billable hour, but despite his similarities in fashion choices to a lawyer, therapists billable hours don’t usually work the same way. Their fee should partially factor in doing some tasks outside of the session. This is why the hours are 50 minutes rather than 60. Every other therapist who I’ve given reports to has made copies and given the originals back to me the next session, rather that using session time.
It’s possible that he just didn’t realize how much trouble he’d have with the printer, so it took longer than expected. But I found a similar trend in the 5+ minutes spent discussing billing. He mentioned that I’d not brought a check the first session. I hadn’t realized he wanted me to. I thought he was going to bill my Dad. I asked if he could just send my Dad the bill. He wasn’t very into this idea. he really wanted to sort it out right there.
It turns out he takes credit card. I paid with my American express card. American express has a reputation for charging a lot in fees to vendors. I hope he got charged a lot in fees for being too lazy to send my Dad a bill. I get that maybe a lot of patients don’t pay bills promptly, but my Dad is very reliable about these things. I’m not sure if my credit limit can handle getting too many of these charges. I usually just use it to buy food.

It makes me really anxious to see the sticker price of sessions. When I submit it to my insurance company for reimbursement the cost will go down to 15-20 dollars per session, but to see $500 for the two sessions on my receipt makes my heart rate speed up.

This left less than 30 minutes of therapy time.
We had a very uncomfortable interaction where he asked me if I wanted him to help me. He wanted me to say “I want you to help me” rather than me just answering his question with a “Yes”. I didn’t cooperate.
This and a couple of things made him feel more like a bad “self help guru” than a psychiatrist. He listed the 5 things he felt were important in a psychotherapy session and the 3 types of communication he believes exist. It felt trite and cheap and tacky.

The session was very directed towards talking about my childhood. I certainly do believe that my childhood had a role in the types of problems I have today, but he doesn’t even know yet what most of my problems today are. It’s too easy for this type of therapy to turn into time where I just say horrible things about my parents. And my parents (especially my Mom) definitely messed up in some places, but they were well intentioned. I did not appreciate his efforts to make me express anger about my Dad for a situation where my Dad really had no good options. He’s paying the bill! and basically is a good guy aside from his inability to be emotionally supportive.
I mentioned that I am not going home on Thanksgiving and the therapist reacted much too enthusiastically about this. He hardly knows my situation and reacted as if I was cutting ties from an abusive family situation. My family is dysfunctional in many ways, but not abusive. My reasons for staying here are more academic than emotional.

I much prefer information about growing up to come out organically in relation to information I share about the present. I am suffering here in the present. Yes the past influences that, but the present matters too. Dwelling on every detail of my childhood is not conducive to changing how to feel today. Really, it just makes me more miserable.
Is it unfair for me to seek out a psychodynamic therapist and criticize him for wanting to talk about my childhood too much? I don’t think so. I think a therapy can be dynamically informed while having a present focus.

I mentioned how I’m not fond of the pure free association type of therapy and I prefer when it’s more interactive. He said that he agreed and said that he’d once been in therapy with a classical Freudian-type and had hated that style. I am kind of uncomfortable with that self-disclosure, even though I realize it’s very typical for analytically oriented therapists to have had their own therapy at some point. It felt like over sharing.

When working on the billing, he asked what ICD code I wanted. I’ve been asked in the past what diagnosis others have used for the bill, because they want to be sure I get reimbursed, but never flat out asked which code I wanted. I opted for Major depression, recurrent, moderate, because I’ve had that used a lot in the past.

I’ve been trying to do work on the train, so I don’t feel the time is wasted, but unfortunately I’ve been so tired, that I’ve not been very productive. Maybe as it becomes more routine it will be easier.

I’ve been having a lot of reactions to the idea of going to Second-Closest-City for therapy. When I was calling places looking for a therapist, they’d ask where I coming from and I’d tell them and as soon as they wondered why I’d come so far, I’d start crying. I’d hardly be able to speak.
I feels like it’s some kind of punishment for being so crazy. I’m so messed up I can’t even find a therapist in a city filled with therapists. 3 of my former therapists are within a 5 block radius of my home.
I’m mostly keeping these trips private, people would think it’d strange for me to go to this Second-Closest-City for a couple of hours only. I feel like I’m going on these secret adventures that I can’t tell anyone about.

Some of my professors commute from Second-Closest-City to my city. I have a slight fear that because I am taking such an early train that I might run into them at the train station in Second-Closest-City. I’m not sure how I would explain seeing them there, then seeing them in class later that day. It’s close enough for a commute, but far enough that people don’t usually just stop in for the morning.

There are some upsides though. If I were to be hospitalized, I’d be hospitalized there and my confidentiality would be safer than it could be in any hospitals around here.
I also feel like in this other city, I am suddenly free from a lot of my worries about privacy. I’m in this city where hardly anyone knows me. It’s liberating.

I have some serious doubts that #26 is going to work out. I’ll give it one more appointment to see if things improve, but otherwise I’ll move on. If nothing else I’ve learned that Second-Closest-City is a viable option for finding therapy.

The more you need help the less willing people are to provide it + the intersection of work and treatment

A few weeks ago I decided to give CBT another shot. How is it fair for me to fully reject it as a treatment option for myself, when my experience with it has been so poorly applied?
I picked out a local prestigious research center and gave them a call.

I felt that maybe the failures with my previous efforts to get “real CBT” were because I was looking for treatment in the community rather than from researchers. Maybe this “empirically supported treatment” only exists in the magical world of academia. The treatment outside might share the same name, but maybe it is something different.

In the past I’ve avoided treatment research studies (even though I’ve participated in many other types of studies) because I worried about the guilt I’d feel when I didn’t get better. I don’t want to ruin their study.

I don’t talk about my work here much, both to maintain my anonymity and due to confidentiality rules. I love what I am doing and I am making amazing professional connections. It is doing wonderful things for my developing career, but not so good things for my ability to find treatment. I am very concerned about keeping my crazy separate from my professional life. Most of the people I work with are therapists.
As my therapist list grows longer and longer and my work social network also expands I’m running into increasing problems of overlap between the two. I know that both therapists number 23 and 25 in particular had some form of connection to people whom I work with. I’m sure others have had connections I don’t know about.

S.M has tried to assure me that some amount of this problem is very typical for folks working in the mental health field and that clinicians should be able to handle it tactfully. The problem is that most people only have one therapist they are awkwardly avoiding in their professional life. I have 25 and counting.
If I knew for sure, ‘ok this therapist is the last one I will ever have to see, because this therapist will be a good fit’ then I might be less concerned about the therapist possibly knowing a coworker or attending some of the same conferences as me. The problem is that in all likelihood therapist number 26 won’t be able to help me any more than the other 24 (S.M is excluded as I only left him because he’s located far away). As I see more and more therapists I cut off more and more career options. I wish I could wipe my identifying bits of information out of a therapists head after I fire them.
The ideal therapist for me would be completely professionally isolated, the problem is that someone that isolated is not likely a very good clinician.

It may seem like I got a bit off topic in the above paragraph from my thesis sentence, but here’s where it connects. Something that made this Prestigious Research Center (henceforth known as PRC because psychologists love acronyms almost as much as Unitarian Universalists) a wonderful choice for my treatment is that I have zero desire to work there. We have differing theoretical interests and this is a place that would be particularly hostile for a person with my perspective to work. I could go there as a patient and not feel like I am blocking off a future job opprotunity.

I played telephone tag for a week with PRC and finally got in touch with a fellow who conducted a phone screening interview. I prefaced the interview by letting him know that I realize I’m not the ideal person for their research, due to my large amount of treatment experience and number of co-morbid diagnoses. He said this was fine, because the research clinicians also see patients there outside of the studies.
I thought this was great. I could get the research clinician without the guilt of sabotaging their study.
He said that sometimes they do have to refer people out with certain kinds of problems that they don’t work with e.g. substance abuse. As substance abuse is not a problem of mine, I wasn’t concerned.

I became even more attached to PRC when he told me that all of their patients go through a thorough assessment prior to therapy (things like personality measures, structured clinical interview etc) with an accompanying report.
I have a large stack of neuropsychological testing, but never any formal assessment, independent of the treatment, about the rest of my crazy. If nothing else I was excited about the idea of a beautiful organized report with charts and standard deviations. I adore data. Even if this therapy didn’t work out at least I’d have a report (albeit one biased towards militant CBT research) to show future clinicians.

The phone interview lasted an hour and a half. I was told I’d get a call back from the main desk to book an appointment for the assessment. Instead the fellow from the phone interview called me back to say they were unable to work with me. He’d talked to his supervisor who told him they had a policy of not working with anyone who has had more than 2 hospitalizations in the past 5 years (I’ve had 3). Then he offered me a referral to Other Prestigious Research Center.
The problem? Other Prestigious Research Center is where I work. Not in the specific part he referred me to, but very closely affiliated with it. This isn’t just a matter of me being obsessed with boundaries where I avoid people even loosely associated with my work. This is closely related enough that it would be unbelievably inappropriate for me to look for treatment at this particular location.
I was so taken by surprise that I actually told him why I couldn’t use that referral. An unusual self-revelation for me.
He got back to me the next day with more referrals except this time for people in private practice. When I googled them it turns out they both worked at the same Other Prestigious Research Center that I have to avoid.

So my plan of getting CBT was foiled again. I called S.M. asking for a referral. I feel so awful coming back to him over and over. He has a hard time making these referrals because he doesn’t know many people in my area.

For the past couple of years he’s been trying to get me to see a “senior analyst” for a consultation. Someone too busy (or mostly retired) to take on any new patients, but who could be a fresh set of eyes for my problems and would know clinicians in my area well enough to select a strong match.
I’d been turning him down, because I didn’t want to add an extra person who knows my problems to the world unless they were someone I was planning to meet with long term. I finally agreed to give this a shot.
He told me a name and I googled her to establish sufficient separation from work. She is loosely connected but far enough apart that I can tolerate it. S.M told me he would give her a call and see if she could see me for a consultation.

It been a couple of weeks. I’m not sure what’s going on. I guess she’s not answering his call? S.M. keeps telling me he expects to hear back soon, but it hasn’t happened.
Meanwhile I’m waiting, feeling like I can’t try to pursue other options (as if I even have any) until this sorts itself out.
I’ll go to work next week where I’m surrounded by therapists, while I am still unable to find a therapist for myself.

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.

CBT therapist

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

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

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

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

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

I made a call to one therapist in the morning.

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

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

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

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

I made an appointment and began to feel guilty.

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

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

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

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

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

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

I decided to keep meeting with her.

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

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

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

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

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

She did admit that it wasn’t really CBT.

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

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

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

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

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

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

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

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

DBT Summary Letter

This is a follow up to my post “A roadbump while looking for records”. You should read that first.

I googled the office address of the DBT therapist that I got off of his website. I found the therapist who moved into his office after him. I figured it was a long shot, but called her anyway.

She got back to me promptly and was very kind and apologetic, she said that she didn’t know how to contact him.
But then the next day I got a voicemail message from the DBT therapist. Apparently she had found a way to get in contact with him. He didn’t leave a number in the message, but said he would call again to try to reach me later.

I waited a bit over 2 weeks without a call back from him. I had no phone number to call him at. I called back the therapist who had moved into his old office and left her a message. Shortly after, I got a call from the DBT therapist. I wasn’t able to get him to agree to send full records (not a surprise) but he agreed to send a summary letter.

Finally I got a letter from him in the mail. No return address listed. I think he must not be practicing right now, because I never got a contact phone number for him and the letter doesn’t even have an office address as a heading or footer. Also, after speaking with him he took down the entire website with his outdated contact information.

I scanned the letter and put it up here. Edited out some identifying bits.

The envelope was post marked April 9th. So it took over a month from when I started at the end of February trying to contact him to when I got the letter in the mail.

This was probably the most work I have gone through to get any records and the least fulfilling.

It reads mostly like a textbook explanation of DBT. So little of the content of the letter feels specific to me.
I got a kick out of the bit where he wrote “We discovered several vital functions and reinforcing properties of her self harm..” as if I hadn’t already had an understanding of these before meeting him.

I realize 12 sessions is not a huge number of sessions, but I don’t think it is an insignificant number either. I get the feeling reading the letter and based on our no-pleasantries-exchanged-phone-conversation that he didn’t remember me and struggled to write the letter based on a few scribbles in a notepad.

I was most interested in how he would describe terminating the treatment.
He kept telling me that I needed to call him if I was going to cut. If I couldn’t agree to call him then he told me we couldn’t meet any more.

Phone anxiety aside (This has gotten better over the years, but never completely gone), I didn’t want to do this because it is hard for me to judge if I am going to cut in a situation or not. I don’t really know if I’m going to cut until I’ve done it. I think about cutting a lot. Only a very small percentage of the time do I act on it. If I called him and then did not cut after the phone call (even though the purpose of speaking to him was to help me avoid cutting) I would have felt guilty for making the phone call. If I didn’t cut then, I would have bothered him for no reason. I’d have worried I had called him during a time when I wasn’t going to cut anyways. I probably would have half-heartedly made a small injury to ease my guilt.
His request for me to phone him would actually increase my self injury rather than decrease it. And I’m fine with my self-injury in general (I was pressured into going to the DBT and was very ambivalent about it) but that doesn’t mean I want to intentionally enter into a situation that will needlessly increase it.
I’m not sure how well I articulated that to him. I’m better at expressing some of these things now, because my meta-cognition has further developed.

Whatever the reason, he doesn’t appear to have understood my objection to the phone calls. Still I had often wondered if he realized he messed up when he told me ‘phone calls or no therapy’. I imagine he thought the ultimatum would get me to fall in line with his rules, but it backfired and I left.
His letter reads as if it were more of a mutual agreement, instead of a “do this or leave” command.

Would people be interested in more posts like this where I post some of my records with comments? I have a few other topics I want to talk about here first, but if people are interested, I can also do more like this one later.

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.

Stolen Therapy

Someone stole my therapy appointment today. I saw it happen.

I’ve been out of therapy since the beginning of August. I’ve been trying to get back in it since the beginning of September when I had my little freak out.

I had finally had an appointment scheduled for this morning. I dressed in a cute outfit, which is very much in contrast to my routine ‘stay inside doing homework outfit’ that is typical of my Thursdays.

I wasn’t at all familiar with the neighborhood his office is in (despite the location being close to my home) so I left early. And by early I mean I allowed an hour an a half for what turned out to be a 20 minute trip.

I have a thing about not entering therapist offices more than ten minutes early (earlier feels invasive on my part), so I walked in circles around the area and killed a lot of time in a coffee shop.

Finally, 10 minutes till the appointment I went into the waiting room and I sat down.
A few minutes later a man, probably late twenties early thirties, enters the waiting room.
‘Do we just wait here, or..?”, He asks

I shrugged and said ‘I assume so, it’s my first time here’
It was clearly his first time as well.

Then commenced the awkward situation of being in a small waiting room and attempting to avoid all conversation and eye contact. I stared intently at the generic waiting room art.

At Noon, my time for the appointment. A guy walks out of an office. ‘Is one of you here for Dr. X?’
The waitingroom man says, “Yes” and follows the guy into an office.

I have a auditory processing disorder. One of the things that means is that I have a lag time for understanding auditory info. So basically I didn’t understand the sound part of what happened until after both people were gone.

Dr. X was the doctor I was there to meet with.

I sat there for 10 minutes trying to figure out what happened. “Maybe they’re only meeting for a couple of minutes”, “Maybe he accidentally double booked”, “Maybe I was supposed to show up last week”, “Maybe my appointment is later today”, “Maybe I showed up at the wrong address and it happens to be the office of another psychiatrist who happens to have the same name in the same general area”

I felt  uncomfortable,like I shouldn’t be there, even though I knew my appointment time was correct. I’m very careful about these things. I check and recheck when writing it down. I read it back after writing it down as well. The probability of me writing the wrong time down is very small.
Ten minutes of this and I went into the hall and called my parents. I watched the door to see if this man would leave making my appointment available again. Twenty minutes past, against my parents advice that I should either phone the therapist or knock on his door, I left to go home.

I’m so busy. I’m juggling full time school, an internship, leadership roles in extra curricular activities and maintaining my ridiculous GPA standards. I hardly had time for this appointment. I especially I don’t have time to sit in an waiting room for an hour to wait for an appointment that isn’t happening.

I forced in into my schedule. Because I need it badly. My word repeating is at an all time worst. I’m terrified my neighbors can hear, because the volume is much too loud. Every night I pick apart my day and beat myself over every awkward imperfect interaction. There are a lot of them. One thing I am good at is creating awkward moments.
I don’t have time to sit in an waiting room for an hour to wait for an appointment that isn’t happening.

I cried my way home. Wow that’s a cliche sounding line. Sorry about that.

I didn’t feel comfortable calling the therapist. I considered not doing anything, just forgetting about this therapist so I could avoid the awkward interaction that would result from confronting him about this issue.

I whined to my Dad a lot on the phone and finally I agreed to let him call the therapist. I gave him permission just to gather facts, not to make a new appointment.

Here’s what happened:

-That man didn’t have an appointment at all. He’d just shown up. He wasn’t even already patient. He was just a person who showed up.

-The therapist hadn’t checked to see who his next appointment was with before going to fetch someone from the waiting room.

-When that man was able to react faster than me, he stole my appointment (Who does that!? Did he think therapy was just some sort of drop in thing?) and it took the therapist a significant part of the appointment to realize what had happened.

-Then the therapist went into the waiting room to look for me, but I was long gone.

I made an appointment for next week. I’m willing to give this guy another shot, though I’m not pleased about the whole situation. It threw off my homework schedule badly, because I was too upset to get work done. The only work I got done today was the work I did before I left to go to therapy.

In all my hypothetical situations I wondered about in that waiting room, the idea of someone stealing my therapy appointment wasn’t one that would have ever occurred to me.

Buzzers

I hate when therapists have a buzzer that I need to ring to gain access to their office.
I generally have a bit of pre-therapy anxiety, the buzzer exacerbates the situation.

I hate being late for things, but I also have a rule about not being more than 10 minutes early for things. Any more than that and my early-ness can seem excessive to an onlooker. I need to be early so I don’t stress about being late, but I don’t want people to notice how early I am. I tend to show up for therapy (among other things) early and walk around to kill time. It is important to maintain sufficient distance from my destination (1 block at least). I wouldn’t want my therapist to spot me near his office an hour before the appointment.
When an office has a buzzer it means announcing exactly when I show up. Are they noticing how early I show up? Am I being rude by announcing my arrival 10 minutes early rather than 1 minute early?

If I sneak in, past the buzzer door, behind someone else will the therapist think I haven’t arrived yet, leaving me waiting in the waiting room indefinitely?

I worry about pressing the wrong button and buzzing someone else. I’ve done that before. I had a class where the professor held classes in her apartment (I know, weird right? She was a strange lady, always giving me free hair product. She had cats though so that was awesome) We had to press the buzzer to get in. Once I accidentally buzzed one of her neighbors. Very embarrassing.
I have to check and re-check to make sure I’m pressing the button corresponding with the correct name. Sometimes the list of names is far from the buzzer, allowing more room for potential errors and therefore more worrying.

Once I got my belt from my coat stuck in the door of a therapist’s office that had a buzzer. I tugged hard trying to free the belt and eventually had to get buzzed in again to free myself. There were moments where I considered sacrificing the belt to avoid the extra buzzing, but I worried she’d notice the belt left behind and comment when I arrived next time missing a coat belt. The belt has since been lost after a dry cleaning trip. It just really didn’t want to be on my coat. It’s a shame since I picked it out because of the belt. I felt a coat with a belt produced a better silhouette.

The first time I tried discussing the problem of buzzer with a therapist who had one, she took it a little personally. So I dropped the subject. I didn’t meet with her very long. It might have lasted longer had there been no buzzer.

I later met with another therapist in the same office building. He and I came to the agreement that I’d sneak into the building behind someone else. He didn’t mind, apparently he too hated the buzzer. His reason was different. Often he didn’t hear it and wouldn’t know people were waiting. This method of sneaking in helped, but still was stressful. I’d very slowly preform tasks that made me look busy, like I wasn’t trying to sneak in. I’d slowly unwrap my scarf or look at my ipod or phone. I needed to show up more than the 10 minutes early to allow more time to sneak in. But sometimes I’d get in the building way before the appointment, meaning I needed to walk slowly up the stairs to avoid arriving in the waiting room more than 10 minutes early.

I don’t have a id card to get me in the building for my internship yet. For at least a week more I have to get buzzed in to enter the office. To complicate matters not everyone works there every day. I have to buzz multiple people (Many who I hardly know yet. I worry if I say my name and ask to be let in they’ll be confused about who I am.) to find one who is there who can let me in. I’ve been working to avoid this by showing up during the morning at peak arrival hours so I can follow someone else in. It’s in a nice neighborhood and I’m sure I could find fun places to eat during my lunch break, but I’ve not been leaving the building for lunch because I don’t want to be re-buzzed in.

I returned to therapy Tuesday with S.M. He got a new office. I was taken by surprise when, after making the appointment to meet with him again, I learned that his new office has a buzzer. It hadn’t occurred to me that he could have become a buzzer person in the past year.
It amazes me that even with the amount I worry, situations still manage to come up that I hadn’t foreseen.
I stressed a lot about the buzzer. It ended up being the least bad buzzer I’ve encountered. Don’t get me wrong, it’s still a buzzer (Wait and see, I’ll turn the word buzzer into an offensive adjective) but I’ve seen much worse. This one was interesting in that I pressed a button to scroll to his name (first one on the list) and then pressed the call button. I like that I only have to see one name at a time and that his is the first. Less worry there about buzzing the wrong person. Other worries are still there but cutting out one problem helped. It also helps that this is my favorite therapist and I appear to have come down with a bad case of idealization. If he were a new therapist with the same buzzer I might be more critical.

Today at the end of my appointment I walked out of his office, through the waiting room, outside the waiting room to the elevator. My therapist followed shortly behind me and said “Here let me show you something” and then showed me the code I can use to get into the waiting room. No more need for a buzzer. Leaving me puzzled about why he did this.
-Did he remember that I have trouble with buzzers? I only mentioned it once to him, briefly(On the phone during a time I wasn’t even meeting with him and just wanted records). I’ve been assuming he forgot about it. I hadn’t talked about my stress over his buzzer, because I didn’t want to be rude. I’m sure he didn’t choose for the office to be designed with a buzzer. Did he offer it without me asking because he knew I wouldn’t ask?
-Does he tell the code to all his patients? If so why didn’t he just tell me it on the phone when I made the appointment. Why wait till after the second session? And why after I already left his office?
-Can he tell if I’ve just used the code? and if so maybe it’s a sneaky way to see if I show up earlier when I don’t need him to buzz me in. I won’t fall into that trap:P 10 minute rule still applies.
-Maybe he thinks he’ll run a little late some day and then without the buzzer I can let myself in even if he’s not there yet.

I guess it’s a sign he’s not worried about me breaking into the waiting room or something. :P
I’m going to think of it as that he remembered my trouble with buzzers and view it as a nice gesture. Perhaps I’ll get an explanation about it at my next appointment. Probably not though. And I doubt I’ll ask. Maybe I will. Or maybe not. He’d probably tell me if I asked, but that would require actually asking.

“I don’t know”

I say “I don’t know” in therapy a lot. This isn’t a very good thing. It’s equivalent to someone in improv saying “no”. Everything comes to a halt. It messes up free association pretty badly.

The majority of the time I legitimately don’t know how to answer the question. Sure there are times when I say that to get out of answering something I don’t want to talk about, but most of the time this isn’t the case. Unfortunately people don’t tend to believe me when I say “I don’t know”.

There are certain types of questions I have trouble answering. Broad generalized questions that I hadn’t considered the answer to before.

For example I would have trouble answering “What was your favorite thing about yesterday?

Things from yesterday might pop into my head while I strain to try to figure out the answer and they’d feel just out of reach. My mind goes blank and gives up.

But if the question was rephrased to “What was one thing you found enjoyable about yesterday?”  I could answer that. It’s a similar question, but not the same thing. The first requires accessing all of the memory about yesterday’s events and examining it in a new way to come to a new conclusion. This second question only requires accessing my memory and finding one that is already associated with being enjoyable. There is no manipulation of the old information.

If yesterday you had told me “Tomorrow I will ask you what your favorite thing from today was“. I could go about my day making mental notes as I went of a hierarchy of favoriteness. Then when asked “What was your favorite thing about yesterday?” I’d be able to answer the question. The problem is with accessing the old information and manipulating it into something new.

This is not a problem in my day to day life. Generally when a person responds “I don’t know” to a question the conversation is able to continue. In therapy however it is a problem, because it is a mostly one sided conversation. Just one of the many reasons why I’m a pain in the arse to work with.

One therapist suggested that it was a problem with executive function. Unfortunately executive function is a very vaguely defined term. I do think this is an interesting idea though.

I’ve taken many neuropsych tests and one of them is a test where the person needs to name as many words as they can all beginning with a certain letter within a time limit. This is one test used to assess executive function. I never do well on it.

The context of where I take the test though impacts how I score on it. I would do worse in an empty room than one with more items in it.

Supposed the letter I am trying to find words for is “W”. I would look around the room for visual clues when I get stuck. If I see something that begins with that letter I’ll say it. The more interesting part is how I can use the visuals to get to words that are not in the room. If I saw a computer keyboard I could use that to get to the word “write”. The visual information can act as a launching pad. Clues can help me find information that I had all along but couldn’t access.

This same concept can be applied to answering the generalized questions. Suppose I’m asked series of specific questions that hover around the topic of a question I can’t answer. This can help me gather enough information to answer the original difficult question.

In my first week of college I had a class where the prof decided to start off with a icebreaker game. Ew. The game she chose was for her to pick a color and each person had to come up with as many things that were that color as he/she could. She wasn’t aware that this was similar to a popular psychological test. I got orange. The only thing I came up with was the fruit orange. I had a panic attack when I got stuck. Not really the greatest way to start off college.  Of course after class on the way home I spotted orange traffic cones.

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.

Updates:
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