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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by CareBear04 on January 18, 2008, at 22:50:52
I don't know why, but I just can't bring myself to talk in therapy. Part of it, I know, is mood-dependent-- when I'm manic, I can't shut up, whereas when I'm depressed, I don't feel like talking at all. In the past, I've frequently had trouble initiating conversation, breaking those long silences, so my pdocs have taken on the task of asking questions. With one pdoc, I was also worried about shocking him and disrupting his conception of me as innocent and wholesome, so I was really embarrassed about personal details, particularly relating to my sex life. Right now, though, I can't even really answer general questions about how i'm feeling, and I dread the point of the appointment when we move from meds to the talking. for a lot of reasons, I seem to leave appointments feeling worse than before.
Even though I'm more reserved when I'm depressed, the way I'm acting in therapy is a new low. THe neuropsych tests I once had said that I was very neurotic but also very extroverted, which the psychologist said was an unusual combination. No matter how bad I'm feeling, I can usually muster up more enthusiasm or at least a semblance of responsiveness when I talk to someone. A couple of weeks ago, my pdoc wanted to point out a discrepency he noticed. He dialed my cell #, waited while it went to VM, then put it on speaker for us to listen to the message. I had no idea where he was going with this, until he disconnected, looked at me and asked me who that person was-- that she sounded bubbly and happy, completely different than how i was in therapy. it's true-- i'm so far removed from the person I was, and it makes me sad and hopeless about getting back to that state. i wish i could be more talkative with him; i'm upset at myself because i can't seem to make myself.
Until the past couple of days, I thought the problem was entirely me; that the therapeutic relationship was fine, and it was just my fault that I couldn't talk more. My appointment yesterday, though, frustrated me so much that I wanted to scream at him and run out. I'm starting to wonder whether part of the reason I don't talk is because I don't see the point. he seems to think my situational problems stem from my expectations and standards for myself, which, to him, are fundamentally faulty. I don't doubt that I'm unhappy because I feel stuck on a path that I hate, but platitudes like "you don't have to do anything you don't want to do" and "follow your heart" do nothing to convince me to abandon what i'm doing and just make me feel upset and misunderstood. It also seems hypocritical for an MD to keep telling me that I shouldn't pursue a professional degree, when such a degree is very likely necessary to do the work I want to do or that I have tons of time and there's no time to rush. I guess he could be realizing these things in retrospect, but he certainly didn't apply these ideas to his own life. We seem to have a clash of perspectives, where he wants to impose the viewpoint from having finished his education and training while I just want him to set all that aside and remember how it felt to be starting that process. Sure it may be true that the difference between an A and an A- is insignificant when you're established in your career, it is not much comfort to be told that when you're still a student. I know my perspective is way too narrow, but lectures about what matters or what my priorities should be aren't helping. I feel like I have a lot of factors complicating his simplified analysis, but some of them feel private and, in general, I just can't bring myself to speak up. and if i ever do start to talk, there's just so much going on in my head-- so much anxiety, insecurity, isolation-- that i think i'll embarrass myself and never go back.
Since I was diagnosed, I've had therapy between once a month and three times a week. Before, I was seeing this pdoc about every two weeks, but last week, he suggested increasing to every week. I agreed, mostly because it would make it easier to adjust the meds, but now I'm wondering whether it's a mistake. Therapy has been making me feel worse. I can't keep up my end of the conversation. I don't know whether our views can be reconciled, and I don't even think I could bring the issue up. There seems to be competing considerations as to frequency-- i'm not in a very good place right now and should probably be followed more closely, but the appointments aren't helping. Should I ask to go back to the 1/2wk arrangement or maybe just do med check appointments every week? Or are there other options or suggestions?
Thanks!
CB
Posted by star008 on January 19, 2008, at 7:13:00
In reply to Completely shut off in therapy, posted by CareBear04 on January 18, 2008, at 22:50:52
Carebear,
It sounds to me that the two of you don't connect on the level that you need to in order for you to speak freely and that maybe he doesn't understand the way you see things. It is hard to know what is going on but tht is the way it sound to me.. If you are going to be judged, then why would you say anything at all?? Are you leaving upset cause he is not getting it?? I think it would be hard for me to talk too if I thought my view of things wasn't going to be taken seriously or I was just going to get corrected. Have you thought of seeing someone else for therapy and leaving just the meds to him??
Sorry you are going through all of this. I hope it works out for you. Have you tried to tell him what you have written about here?? Your post is well written and makes sense. Could you force yourself to make a copy and give it to him? Tht would get your point across, i think.
Posted by Dinah on January 19, 2008, at 9:53:47
In reply to Re: Completely shut off in therapy, posted by star008 on January 19, 2008, at 7:13:00
I think Star is right. You do write well. Can you think about bringing in your post? Or something you write based on your post?
I did that a lot for a while. I was at a loss on how to say things to him in words, or I got flustered and lost my point. A lot of times when I brought something in writing, he'd understand better what I was saying because I had time to organize it.
Posted by CareBear04 on January 19, 2008, at 12:14:21
In reply to Re: Completely shut off in therapy, posted by Dinah on January 19, 2008, at 9:53:47
thanks both for answering! i don't know if the problem is that we're just not connecting or whether the problem is all just me. in a way, i think i would feel like questions were intrusive and be reluctant to answer no matter who was asking them. i've never been good at therapy; when i've looked forward to going or left feeling better, it's usually been because the T and I had a routine of just talking about anything-- books, movies, travel... anything. I think I liked the sessions because it was nice to feel connected enough to someone that I would speak freely and he would, too, and not to feel backed into a corner. i guess i didn't have many acute issues at the time, so maybe the situation now is too different. and i think i'm out of practice as far as having real, genuine conversations where I reveal, either through words or expression, what I'm feeling. Most of my close friends are across the country, and I've been terrible about keeping up with them. I'm not close to anybody here, and I can go days and weeks without moving past chit chat. i guess i feel really isolated, and it seems to reinforce itself-- i stop confiding in people and start avoiding situations where I might have to, I get used to keeping everything private, then I feel resentful when my pdoc starts prying and, as the end result, I might just quit therapy. He seems to have set ideas on what should help, but they haven't helped me. A couple of sessions ago, he asked me to recall a childhood memory where I felt really strong emotions. I could think of a couple, but they would require lots of effort, plus animation I couldn't muster up, to explain, so I gave a lame example with very little emotion attached. When he pressed me about how I felt, I couldn't really answer, so I had to confess that I just picked one that seemed easy to explain. He seemed mad at first, telling me I picked a surface issue for the wrong reasons. I finally responded that I didn't want to think about the times when I was really happy because it's so far removed from how I feel now, which makes me feel even worse and hopeless about regaining the potential to be happy again. I didn't realize I felt that way until I said it, but it's true-- remembering times when I was outgoing and popular just makes me feel like that much more of a loser now. anyway, my explanation placated him, but he noted that many patients are encouraged by their happy memories, and that I should think of putting together an ipod playlist or something to remind me of those times. that seems like an example of a connection and a disconnect at the same time, which is, i guess, representative of our sessions in general. but i don't know that i would do any better right now with someone else.
thanks for the suggestion about writing down my thoughts for him. i guess it's an option to consider, although I think i would obssess way too much over it and then want to run out of the room while he's reading it because i'd feel so exposed.
i don't know... i don't think i would be worse off without therapy. i don't have the time or the energy to be established with someone new. maybe i should just go with 20-min med checks?
thanks again!
cb
Posted by Dinah on January 19, 2008, at 12:23:49
In reply to Re: Completely shut off in therapy, posted by CareBear04 on January 19, 2008, at 12:14:21
I really like this post too.
You write very well and express your thoughts very well.
It sounds as if some of what's bothering you are real life problems that would respond better to therapy than to medications? Isolation is such a difficult problem in today's society. Most of my friends are friends from high school, even middle school. And many have moved or died or drifted away. I don't really feel like I fit in many places. I've just recently found a Sunday School class that I feel really at home in. I feel accepted in real life for the first time in a very long time.
I don't know if that's something that therapy can help with. I'm pretty sure that therapy helped me get to the point where I could feel comfortable with people. And I remember distinct times where it helped with certain situations.
It kind of seems like another way to isolate yourself, to quit therapy altogether. Isolation can feel safe, and quiet. But it doesn't sound like you're happy with it?
Posted by star008 on January 19, 2008, at 15:54:09
In reply to Re: Completely shut off in therapy, posted by CareBear04 on January 19, 2008, at 12:14:21
care bear
sometimes i write something and just force myself to give it to him. It is hard and yes, I feel exposed but it gets my point across and says things that I can't bring myself to say.
sorry this is short.. gotta go to work
Posted by CareBear04 on January 19, 2008, at 21:21:41
In reply to Re: Completely shut off in therapy » CareBear04, posted by Dinah on January 19, 2008, at 12:23:49
thanks dinah. you seem like someone i could really talk to or even just be with and know that there's understanding. i guess i miss having those relationships more than i acknowledge. you're right-- i think people nowadays are more likely to be isolated that, say, a generation ago as it becomes easier to move around and easier to neglect old-school forms of communication. but i feel like i don't even deserve friendships, having been so bad about keeping in touch and being so caught up with myself. anyway, i don't feel like i fit in anywhere now either. that bothers me, too, because it used to be that i kind of made my environment adapt to ME; now i shy away from drawing attention to myself and would rather be alone. i'd like to think this change is just due to depression, but maybe this introversion and isolation is permanent?
i'm glad you feel comfortable and accepted at your Sunday School class. i actually had a group like that last year-- a Girls' Bible Study group one night a week. more than anything, it was a weekly challenge to open up and honestly share what was going on and feel understood and supported. since then, the group leader has moved on, and my nights are pretty unpredictable, so i don't have anything equivalent.
you're right that to quit therapy would be accepting isolation, and that it's an easy way to go. it also feels like what i should do because i feel contagious, like unless i put on a false front, i'll pull everyone down with me. it's just such an effort to pretend everything is great, to always be positive and sweet. it's a no-win situation-- drained from pretending, guilty for being a burden, or destined to isolation. i even feel guilty for not being more interesting and entertaining for my pdoc. i with meds alone were the answer, but i know they never will be. still, if i can just climb in bed and avoid the world for awhile, maybe time, or time and meds, will do just enough to help me face life and people again. i think you pointed out the heart of the problem-- i'm not happy being so isolated, but the effort and guilt associated with inserting myself into society make aloneness more appealing as a default.
i dont' know...
Posted by CareBear04 on January 19, 2008, at 21:44:32
In reply to Re: Completely shut off in therapy » CareBear04, posted by star008 on January 19, 2008, at 15:54:09
thanks star. i hope work was ok. yeah, i know there are things i really need to do to get un-stuck-- that changing my situation requires taking affirmative action, like in this case, where i need to find a way to get my point across with my pdoc. even though i'm aware of deadlines and requirements and importance, i just can't bring myself to act. and i hate myself for this; avoiding things definitely doesn't decrease my anxiety, and i end up more depressed because i'm too pathetic to do anything to change the circumstnaces that are bringing me down. this situation with the pdoc is just another instance of not being able or willing to try to make things better. it's not so much that i'm afraid the consequences will be worse than the present. i think with everything, i'm just unsure, really really unsure about everything, and so i can't or won't take chances and so get stuck with the default.
out of curiosity, what type of things have you written and shown your T? how did he react?
thanks for responding...
cb
Posted by Dinah on January 20, 2008, at 0:06:22
In reply to Re: Completely shut off in therapy » Dinah, posted by CareBear04 on January 19, 2008, at 21:21:41
Thanks, CareBear.
I really doubt it's permanent. But it can be a vicious cycle. Depression can make you want to isolate. And I think there have been a number of studies that show that isolation can contribute to depression. Or a strong support network can cushion it. Something like that. I'm probably putting it all wrong.
You don't need to be interesting or entertaining for your pdoc. And always trying to appear sweet and positive would seem like a rather superficial form of interaction. It doesn't sound as if the Bible Study Group was like that at all. The lighter acquaintances can be nice too, of course. Not all relationships can be or should be deep, I guess. But therapy is supposed to be one place you can be yourself.
My therapist used to (and probably still does) approve of my involvement on Babble as a form of interaction that was within my comfort zone. Maybe you can find that sort of interaction, either on Babble or someplace else you feel comfortable. Until you feel ready to engage yourself offline? Just a thought...
Mind you, I'm being a terrible hypocrite. I'm right at this moment wanting to call and cancel my therapy sessions until I feel better for fear of disappointing my therapist.
Posted by star008 on January 20, 2008, at 8:45:26
In reply to Re: Completely shut off in therapy » star008, posted by CareBear04 on January 19, 2008, at 21:44:32
carebear,
i have taken very personal things to him that I just couldn't make myself say. things that really exposed me.. It was hard and I did feel like one of those dead bugs pinned to a piece of cardboard for him to look at.
He doesn't mind written things at all and it seems to get across what I am trying to say. He's been understanding every time.
I do the same things that you do.. I get stuck and an afraid to make a move to get unstuck. I would rather not be comfortable than to hae to be more uncomfortable with something new. But new things usually work out aftre the inital discomfort. I have found that one of the worst things I can do to myself is to wait until I am forced to make a move..Then the decision seems to be made for me,, i don't know if that makes sense, i just got home from working all nite and my brain is fried
Posted by CareBear04 on January 21, 2008, at 22:47:24
In reply to Re: Completely shut off in therapy » CareBear04, posted by Dinah on January 20, 2008, at 0:06:22
it's funny isn't it, that we pay them for the therapy time and then still feel this obligation not to bore or disappoint them? what is the source of this duty? is it the specific relationship with them or part of the broader issue of the role we generally assume with respect to other people? anyway, it does seem a little absurd to pay a lot of money only to come away feeling guilty.
Posted by CareBear04 on January 21, 2008, at 23:06:43
In reply to Re: Completely shut off in therapy » CareBear04, posted by star008 on January 20, 2008, at 8:45:26
it's definitely easier for me to express things that i'm uncomfortable about in writing, although i've rarely had the experience of actually being there while the person read it. i imagine it would be just as you described-- really, really uncomfortable. i think i have a hard time standing up for myself or making requests, and it's easier for me to make a statement and lay out my reasoning without being interrupted or having to see their immediate reaction. surprisingly, though, i haven't always gotten good responses from written communication, especially emails. there's definitely something to be said for being physicially present in conversation and able to see and hear emotion and read body language. without that, it's so easy for things to be taken out of context... i think i'm just making excuses that will tip the balance against writing my thoughts down for my pdoc. it would be easier if i could find a way to combine the best of both worlds for the least painful form of communication.
This is the end of the thread.
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