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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by CareBear04 on April 11, 2008, at 19:38:49
what is the extent of a T's duty to the patient? i have a hard time asking my T for help.
i've been seeing my T for over six months now, but most of the time, i still have trouble talking to him. there's a lot of silence at my appointments. mostly i just look to him to manage my meds. he's been good, though, about communicating that he's avilable after hours. in the fall when i was really depressed, he called me every morning and over the weekend to check in. a couple of times, i've experienced lithium toxicity, serious dehydration, and other bad symptoms but never called him and waited until my appointment. at each instance, he asked me why i didn't call, and i felt really bad because it never even occurred to me. he seemed sorry that i didn't ask him for help.
so on monday, i had a morning appointment with him. that afternoon, something happened that completely threw me off left me sort of in shock. i wanted to shake it off and do the things i needed to do, but i felt totally paralyzed. i knew i needed to eat, but i couldn't bring myself to eat anything, and all i could do was sit there. my hopelessness was much intensified, and in the short term, i was worried i would hurt myself, though i wasn't sure i could find the energy to do anything. in any case, i felt like i owed it to my T to tell him how horrible i was feeling. i don't know what i wanted from him; i wasn't even sure what i was feeling. anyway, i followed the directions to have him paged. i sort of told him what happened, but as for how i was feeling, all i could say was that "i feel... really bad." i really suck at communicating my feelings, and the more upset i am, the worse i am. he seemed irritated that i'd called without being able to tell him how i was feeling and what i wanted from him. what i really wanted at that point was something that would just knock me out and make me stop feeling... some zyprexa or haldol or thorazine or something. but i knew that's not the kind of self-help he wants me to be using, and i was ashamed that i wanted to take the easy way out. so i didn't ask him to call in a script. he asked me whether i had suicidal urges, and i paused awhile and said, "not so much." i didn't feel like burdening him, and i guess i was afraid that he might [over]react and do something like call the cops and have them drag me to the hospital.
he stayed on the phone w/ me for well over an hour, but i felt guilty about every minute. after awhile, he started telling me that he was glad i called, that i reached out to him because it showed that i felt we had enough of a relationship to do that. he tried to convince me that this episode would pass and that he wasn't going anywhere; that he would be there with me to help me through. it was all very nice, but i had a hard time believing that he wanted to, and i felt so guilty about imposing on him at home and requiring him to give me that time.
something he said that interested me was something along the lines of his experiencing a strong countertransference reaction. he explained that it wasn't the negative reaction associated with the word but just a strong empathy with how i was feeling. he said that he sensed that i was really distressed. early in the conversation, though, when trying to convince me that my life wasn't so bleak, he mentioned that he was a psych attending in the ER and he'd seen a lot of people with really hopeless situations. i know he meant to make me feel better, but it made me feel worse, really guilty. i know that i have no rational basis for feeling so bad, and being reminded of other people's suffering makes me feel terrible about asking for help when there are people who need it much more.
anyway, i wasn't buying what he was saying about hope, but i didn't want to occupy any more of his time, so i wrapped it up. he asked if i would call the next day to let him know how i was doing, and i hesitated, then agreed "for tomorrow at least." he said that was good enough; we'd take things one day at a time.
i don't know what caused me to call him at night. i guess i felt like i had a duty to give him a chance to help before doing anything to myself. but what can he really do to help? i especially don't want him to feel compelled to expend energy on me. and i have a hard time believing that he would do it except out of obligation. i guess i have a hard time believing that i'm any more than a source of income and that he could have any emotional investment in me.
so what is the standard of care required of a pdoc with regard to an acutely distressed patient? what are other people's experiences with contacting their Ts outside of their appointments? do Ts really care about their patients enough to gratuitously offer their time beyond the appointments? am i the only one to feel guilty?
if anyone has any thoughts, please reply.
thanks!
cb
Posted by Phillipa on April 11, 2008, at 20:52:20
In reply to depending on your T (kinda long), posted by CareBear04 on April 11, 2008, at 19:38:49
Seriously? Mine has a recording that says if an emergency call 911. Phillipa
Posted by star008 on April 12, 2008, at 7:43:55
In reply to depending on your T (kinda long), posted by CareBear04 on April 11, 2008, at 19:38:49
I feel guilty when i have to call my T too... Not as bad as it used to be. And knd of like you , I call and then don't know wht to say cuz I don't really want him to think I need to got to a hosp or anything. Mine has never called to check on me.. that is a nice touch..
Posted by raisinb on April 12, 2008, at 7:52:04
In reply to depending on your T (kinda long), posted by CareBear04 on April 11, 2008, at 19:38:49
It sounds like your T is being wonderfully supportive. Sometimes it's difficult to accept or believe in that, so I at least try to find ways that it's not real or won't be there tomorrow.
I struggle with this issue a lot. I didn't call my T once outside of a session (except for scheduling purposes) for about two years. When I did, she was so happy and encouraging about it that I was shocked. It made me rethink, a bit, how I viewed her and our relationship.
We've had many difficulties in our relationship in the past six months, and I have gone back to not calling her, even though she urges me to do it every session. I know she'd be happy that I called--intellectually. But there's a very stubborn part of me that wants to be able to get through things myself, however destructive my coping mechanisms are.
Like you, I also fear she won't know what to do if I reach out for help. It's tough to take that risk and realize the other person can't fix it immediately.
It sounds like what you're worried about, though--that you're taking up too much of his time outside sessions--isn't his perception. It sounds like he is very happy to have the chance to help you through things. If you are worried about it, the best thing to do would be to bring it up at your next session. Conversations like that can be really productive.
Posted by Poet on April 12, 2008, at 15:52:09
In reply to depending on your T (kinda long), posted by CareBear04 on April 11, 2008, at 19:38:49
Hi Carebear,
For the most part my T has been there for me when I needed her. She says it's okay to depend on her and that she thinks our relationship is the first time that I have allowed myself some dependence (she got that one completely right.)
When I was majorly suicidal she called me everyday and yes, she threatened to call 911 on me, which still makes me mad, but I do understand that it would have been for my own good.
I've been seeing my T for 5 1/2 years and trusting her has taken a very long time. I still have silence during sessions, but stare at my shoes far less often. Though I do cross my arms and glare at her.
I think it sounds like you have a T that really does care about you and it's okay to let him.
Poet
Posted by CareBear04 on April 13, 2008, at 20:06:45
In reply to Re: depending on your T (kinda long) » CareBear04, posted by raisinb on April 12, 2008, at 7:52:04
thanks for responding-- it's good to know that other people have the same hesitance to rely on their Ts. i'm not really worried about becoming too clingly and overdependent; i think i just take issue with allowing myself to suck anyone into dealing with my problems. it actually came up in my last appointment-- that my vision of "success" is so career-oriented because any alternate outcomes (e.g., husband/kids/family life) would risk dragging others down with me when the bottom falls out from under me (as it inevitably does).
in any case, you're right that it's hard to ask for help, especially when it can't be immediately given. i kind of feel that if i know that nothing anyone does can really help, then what good can come out of asking my T (or anyone else) for something he can't do?
well, anyway, i have an appointment tomorrow. whether or not i want to talk about the dependence issue, i'm sure the incident will come up.
Thanks!
cb
Posted by CareBear04 on April 13, 2008, at 20:30:38
In reply to Re: depending on your T (kinda long) » CareBear04, posted by Poet on April 12, 2008, at 15:52:09
hi poet-- i guess part of me is a little afraid that my T will freak out and do something like call 911 on me. i know that my inability to communicate frustrates him (as well as me) and increases the risk of misperception. and there are some times, like those you noted, when maybe such a reaction wouldn't be unwarranted. i think the situation is better when he understands that i'm not shutting him out on purpose, but it took awhile for him to get that, and i think he still needs to remind himself of it.
see, when you say that you've been seeing your T for 5 1/2 years, i have an easier time understanding why your T would want to help you. if nothing else, over that time, she must have invested a lot of effort and become really familiar with your life so that she has a significant stake in your recovery. i can't really see that connection with my T. first, i've only been seeing him for about seven months. more importantly, though, i haven't shown him any part of me that he should reasonably feel is worth his effort to save. i've been depressed pretty much the whole time, so the only basis for him to hope for better is [my reports of] past experiences and the "bubbly" (his words) voicemail message he hears when he calls.
just one more question-- how long did it take you to feel like you had a "real" relationship with your T? to the extent that mine does talk about himself at times, i guess i feel like there is some mutuality involved. but to the extent that i'm paying him to talk to me, i can't help but feel like the "relationship" and any feelings arising out of it are artificial. in that sense, especially since we both know it, i feel pathetic depending on him like it's a sign of being a loser with no real person support system.
anyway, thanks for replying...
cb
Posted by CareBear04 on April 13, 2008, at 20:35:42
In reply to Re: depending on your T (kinda long) » CareBear04, posted by star008 on April 12, 2008, at 7:43:55
hi star-- it sounds like you've gotten better, though, about feeling guilty when calilng your T? that's encouraging at least...
how does your T respond when you call and don't know what to say? mine seemed irritated at first that i coudln't express what i was feeling beyond "bad," then as he realized that i wasn't doing it purposefully, i think he felt bad that he couldn't really help. i feel guilty about inducing both responses...
cb
Posted by Poet on April 14, 2008, at 15:10:08
In reply to Re: depending on your T (kinda long) » Poet, posted by CareBear04 on April 13, 2008, at 20:30:38
Hi CareBear,
My T has told me more than once that I am not easy to work with and in the beginning she wasn't sure if she could. It took me years to really trust her and I know my silence and refusal to talk about certain things frustrate her, but you are right that she has invested a lot of effort and she has a significant stake in my recovery.
I think it took about a year before I felt comfortable calling her between sessions even though she told me from the start to call her anytime I need her. So it was probably about a year into therapy before I felt we had a real relationship.
Poet
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