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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by CareBear04 on April 16, 2008, at 0:44:44
i feel completely stuck in every possible way. i'm sure feeling stuck contributes to my current state of being very depressed. since being diagnosed as bipolar five years ago, i've constantly been on meds, but that hasn't prevented lengthy periods of depression and mania and a lot of hospitalizations. i know intellectually that the depression will get better, but i also know that the bottom can and will fall out from under me in the future. for each mood state i get through, i know that i'll be stuck back here again, so i wonder what's the point?
my pdoc has suggested that my cognitive and emotional response patterns combine with the chemical basis to intensify the moods, so that meds alone won't resolve my problems. i know he's probably right. but at this point, i'm not sure i should stick with therapy. maybe i'm not even sure i want to get better anymore, and i feel guilty demanding his attention if i can't commit to this outcome. i also just can't get past this inability to tell him what's on my mind. i finally told him last time (though indirectly) that he made me feel worse by pointing out the people he's seen who are much worse off than i am. he responded defensively, asking whether i thought he was trivializing my problems... whether i thought he didn't know that i was on 10 meds, a record in his career? he said that he mentioned the other patients because there is a crucial difference between them and me-- that i also have strengths to overcome the problems. i appreciate that he answered honestly and didn't give me BS, but i was still kinda stunned by his confirmation that i'm seriously messed up.
my T also pointed out that i kept coming to my appts and that said something. i don't really have any hope of therapy helping me, though, and i don't want to give him the impression that i do. and as long as i keep going, i feel obligated to contact him before doing anything drastic. i think i want to quit in part to get a rise out of him... but i don't even know if he'd try to stop me. i think he knows that to chase after me would just reinforce my "bad behavior". but on the other hand, maybe he knows that, right now, i need him to try to stop me. i need him to show me that i'm worth his time and effort.
i just don't know what to do anymore. any thoughts?
thanks,
cb
Posted by backseatdriver on April 16, 2008, at 8:07:00
In reply to should i walk away from therapy?, posted by CareBear04 on April 16, 2008, at 0:44:44
Had almost exactly the same experience with my T recently. He'd hurt my feelings, and I'd told him so, and also that I was sure he'd rather be working with someone more interesting, who was acutely ill and needed him more.
In reply, he said a funny thing: "Given the mistakes I am making with you, I am afraid I would present a real hazard to anyone who was acutely ill."
Your T knows when he screws up. It sounds to me like he feels as badly as you do about the remark he made (which was thoughtless, to say the least).
You say you'd like him to show you that you're worth his time and effort. It sounds to me like he may be wondering whether *he* is worth *yours*.
If so, he might miss your signal that you need to hear this message from him.
Posted by raisinb on April 16, 2008, at 9:38:17
In reply to should i walk away from therapy?, posted by CareBear04 on April 16, 2008, at 0:44:44
Yuck, that's a very difficult place to be in, and it sounds as if your T could be responding more sensitively. But from reading the post, I'd say he *does* think you're worth his time and effort and wants to work through this impasse with you.
I've been in the same place with my T many times. I once said to her, "I feel like I have to quit to communicate with you."
The problem is that quitting usually doesn't get you the response that you want, because even if the T does chase after you a bit, it's seldom enough to assuage how alone you feel, and it doesn't fix your own feelings of not being fixable or worth it (I might be reading you wrong, so apologies if so :)).
It also puts the T in a difficult position. However much a T wants you to stay, he has to respect your doubts, and he has to respect your decision to quit, even if he doesn't think it will be the best thing for you. They have to be very careful about letting their own desires override yours, even if the two might disagree. So even if him trying to get you back into therapy would help you feel more hopeful, he might not be able, ethically, to do a lot of it.
It might be tough, given your difficulty in trusting him, but a way to get around it is just to express what you want from him directly. Tell him you want to know that you're worth it to him, and see what happens. If you can't do that, maybe you could find a more indirect way to communicate it?
Posted by Happyflower on April 16, 2008, at 10:36:33
In reply to Re: should i walk away from therapy? » CareBear04, posted by raisinb on April 16, 2008, at 9:38:17
hi Care Bear,
You must be so frusterated right now. I know I would be, sometimes I wonder if I will ever craw out of this dark hole, even with meds.
I wouldn't leave therapy, it is too hard to go back.
Maybe tell him you feel like quiting, and see what he says.
Things do get better, but it takes time I am told.
Posted by Phillipa on April 16, 2008, at 12:52:18
In reply to Re: should i walk away from therapy?, posted by Happyflower on April 16, 2008, at 10:36:33
How much time as I'm very resistant to change? Love Phillipa
Posted by CareBear04 on April 16, 2008, at 22:40:52
In reply to Re: should i walk away from therapy?, posted by backseatdriver on April 16, 2008, at 8:07:00
hi backseatdriver-- thanks much for your response. yeah, i know my T does say things that he regrets later. in a way i'm glad about it; i don't think i would want one of those old-fashioned analytic type Ts who don't really give any personal response. when you talked about my T feeling as bad as i do, which remark were you refering to-- the one about my being much better off than people with real problems or the one about how my many meds make me severely messed up?
i'm not sure how i feel about my T wondering whether he is worth my time and effort. the last thing i want him to feel is that i'm too sick for him to treat properly. i really think that would be the last straw for me to be referred to yet another pdoc who "is better equipped" to treat the people with really complex pathology.
argh, i don't know what to do...
cb
Posted by CareBear04 on April 16, 2008, at 23:00:56
In reply to Re: should i walk away from therapy? » CareBear04, posted by raisinb on April 16, 2008, at 9:38:17
hi raisinb--
what did your T say when you told her you felt like you needed to quit to communicate with her?
i know you're right about my T not being able, professionally, to really convince me to stay in therapy. maybe that has something to do with why i want him to do it. occasionally, i have had Ts who have gone above and beyond to keep me afloat. a couple of years ago when i moved back to NY, my previous pdoc called quite a few times just to check in, and we had some lengthy calls. she knew that the change would be hard for me, and until i settled in with my new pdoc, she wanted to make sure i had someone familiar to talk to. i was impressed that she would invest so much effort in someone officially out of her care, time which she wasn't paid for. i had another therapist, a psychologist not even in charge of my meds, who made me call her every night to ensure that i took my lithium when i was really manic and resisted taking it. anyway, these Ts did much more than what was required of them, maybe more even than the profession would endorse. and it did make me feel more worthwhile and more hopeful (btw, you were right on about my feeling hopefully broken and unfixable).
the tough thing about my current situation is that, like you said, my pdoc has given me no reason to believe that he doesn't think i'm worth it. the other day, he asked me how i felt after paging him after hours last week. i told him that i felt guilty about imposing on him, and he said that i wasn't imposing and again that he was glad i called. but i felt like he was ok with it one time but wouldn't necessarily be as ok if i happened to need to call more.
anyway, we'll see how things unfold.
thanks again,
cb
Posted by CareBear04 on April 16, 2008, at 23:06:05
In reply to Re: should i walk away from therapy?, posted by Happyflower on April 16, 2008, at 10:36:33
hi happyflower-- thanks for understanding. i know theoretically that things get better, but i also know that better doesn't last, and that's where i'm stuck. why fight to get through one depressive episode only to suffer from others just as painful in the future?
you said that after quitting therapy, it's too hard to go back. have you experienced this? i think it would be true for me; i have my own pride issues, and i think i would rather save face and move on than meekly go back and ask him for an appointment.
it sounds like we are in a common place, and even though that alone doesn't make everything better, it does help to know that we're not alone.
cb
Posted by CareBear04 on April 17, 2008, at 0:48:27
In reply to Re: should i walk away from therapy?, posted by Happyflower on April 16, 2008, at 10:36:33
since my appointment early this week, i've had all these thoughts that i couldn't or at least haven't said, and i've thought about writing and mailing them to my T. i've been reading through my old journals week, and it brings up a lot of memories than i'd forgotten and some good reasons to call it quits with him.
i called him earlier and left a message telling him that i can't make my next appointment. i meant to say that i wanted at least a break, but i couldn't say it. so i said that we should maybe reschedule... or not. why can't i just say what i mean?!!! i really don't have anything that conflicts with my monday appointment; i'm just confused and conflicted about whether i should go.
so what do you all think about writing the letter/card? i know a lot of people on this board do give things to their Ts in writing or else read aload, but i'm not sure how my T would react. i'm sure it's not unheard of, but i feel like my T already has me in a class of my own as far as trouble goes (compared to what i think is his basically functional and successful patient population) so i don't want to stick out even more.
but that's all assuming that i even continue with him...
thanks,
cb
Posted by Happyflower on April 17, 2008, at 9:06:43
In reply to Re: should i walk away from therapy?, posted by CareBear04 on April 17, 2008, at 0:48:27
I think if you are having trouble telling him what you really want, a letter would be the way to go. In fact it might help a lot for him to know what is going on. Especially about you thinking of terminating, that will get his attention. I don't think you are a trouble maker, you are just asking for help in the best way you know how.
((((Carebear)))
Posted by raisinb on April 17, 2008, at 11:25:23
In reply to Re: should i walk away from therapy? » raisinb, posted by CareBear04 on April 16, 2008, at 23:00:56
Hi CB--
I can't remember what she said, specifically. I went through a loooong period when I threatened to quit almost every session. I did it because I was hurt and scared and I felt like she wasn't hearing me, and I needed to hear her convince me to stay. I guess it meant to me that she cared, that she wanted to be there, that she'd do what she could to listen to me and take care of me in this relationship (which has been quite rocky!) Eventually, I guess she started to hear and meet those needs a bit, and I stopped feeling like I needed to threaten to quit to get what I needed.
I bet your therapist WOULD go above and beyond. It sounds like it, anyway. But I guess what I think is that your feelings of being unfixable, not worth it, might resurface even if he did. If you expressed those feelings directly, it might be more productive and therapeutic.
Good luck with it. These therapist relationships are so, so difficult.
Posted by estrellita on April 18, 2008, at 22:15:55
In reply to should i walk away from therapy?, posted by CareBear04 on April 16, 2008, at 0:44:44
Hi CB,
I can relate to what you wrote about being stuck, and yes it's frustrating and sometimes depressing for me, too.
You said you still feel like "the bottom can and will fall out" from under you in the future, and that even when you get out of a period of depression/mania, you'll experience it again at some point in the future. Until maybe a year ago, I would have said (in fact, DID say, many times) the same thing about depression. I thought it was always going to return and return again, sometimes a little milder, and other times at full force with me feeling like the only alternative was suicide. I felt like eventually I'd attempt suicide because it was either that or spend my life fighting depressions and that wasn't a life I wanted any part of.
Not to trivialize my experiences or yours, but now I feel like while there is SOME possibility that I may go through depression in the future, I have reason to believe that that is NOT how my life is generally going to look. Sure, I definitely am not a sunny person, a complete optimist, or anything like that. But I'm also not fighting for my life on a regular basis anymore. And if someone had told me that would be the case 3 years ago, I wouldn't have been able to believe them, because I didn't even know what a life without that kind of struggle would even feel like.
So, all that just to say that while it FEELS like you know these mood episodes will come and go for the rest of your life, you don't really know that. Now that I've been in CBT and read a list of cognitive distortions about a million times, I've learned that that kind of thinking can be referred to as "fortune telling" - it's a distortion because no matter what we think, we can't predict the future with any accuracy.
Does it help to think about your future (in terms of mental health) as unknown rather than something you're already sure of?
I do think it's good that you continue to go to therapy even though you feel like it's not helping right now. I spent 2-3 years(!) working with a psychologist who I came to trust absolutely, but at the time there were many difficult sessions where I couldn't talk. I wanted to, but it hurt so much to be alive that anything more than dragging myself there seemed so impossible.
What I realize now, though, that even though I haven't seen her for maybe a year and a half, she's still with me, and the memory of some of the sessions is too. I think back to things she said, or things I realized as a result of the therapy, and it helps me at times. Where before there was no knowledge of what my experiences were, or how to cope with them, now I have this mental database that I acquired through therapy, and when I feel a certain way I'll flip through it and find something that helps.
So my suggestion for that is, unless you are sure this particular therapist isn't helping you at all, I would keep going. Even if you don't feel like it's helping you immediately, realize that you're building your own database that you will be able to draw on for the rest of your life.
Have you told him that part of your desire to quit is based on a desire for him to try to convince you to stay? I know what you mean about going back and forth about stuff like that and wondering if I could force someone to show me they care. I really hate when someone suggests something like that - "have you told him xyz?" - but unfortunately it's usually a good thing to open things up when they're bothering you. What could he do to show you that he cares, that he believes that you're worth his time/effort?
Therapy sucks, and it's great, and I hate that sometimes it's great. I hate all the closeness/distance of it, I hate the inevitable loss, I hate all the stuff that feels so foreign to me. But I must believe in it too, and I wouldn't want to go back and see what my life would look like right now without it. Anyway, I so get your ambivalence and confusion and everything else and hope things are working out.
*estrellita
Posted by backseatdriver on April 19, 2008, at 21:08:45
In reply to Re: should i walk away from therapy? » backseatdriver, posted by CareBear04 on April 16, 2008, at 22:40:52
Hi CB,
> when you talked about my T feeling as bad as i do, which remark were you refering to
I was thinking of his defensiveness, actually. Not so much the content of the responses as the tone.
If he hadn't felt truly awful for being such a dork, he would not have responded defensively to your honest and quite justified remarks about his helpfulness. Or lack thereof.
On the bright side, it seems to me that he really cares about doing a good job, and doing right by you.
Posted by CareBear04 on April 19, 2008, at 23:37:07
In reply to Re: should i walk away from therapy?, posted by backseatdriver on April 19, 2008, at 21:08:45
thank you all so much for your responses. i guess the general consensus is that i should let him know what i'm feeling, either in person or, if that's too hard, then in writing. i cancelled my appointment this coming week, but i want to get this matter resolved soon, so i'm leaning toward sending something in the mail.
my T called back in response to my message about not being able to make my regular time, and he left a message in which i felt like he missed what i was saying about maybe not rescheduling at all. so i left him back a message saying that i didn't have much hope of anything good coming out of our work, so i thought i should save us both the effort and not continue. when we were finally able to connect on the phone, i think he played dumb on purpose as to what i was saying, just to make me reiterate it to him directly. discussing the matter was really frustrating. he said he was a little puzzled because it's not even been two weeks since the "after hours call," and at a time when he was recommending that i come more often, i wanted to stop. when i fell into my long silences, he seemed a little impatient and suggested that we table the issue until my appointment the week after next. he said that he felt we need to talk about this matter more, but that if, at that point, i was sure about quitting, he wouldn't force me to continue. he sort of asked whether i wanted to find a new T, and i assured him that i don't; that i just don't want to do therapy at all anymore. he kept telling that therapy takes a long time, that the benefits aren't all or nothing, and that i have so much to live for, but i was frustrated because i felt like he was just missing the point-- i'm not even sure i want to get better anymore, whether there's even anything worth salvaging, and i don't want to delude myself into believing anymore that there's any hope. whether or not therapy could conceivably help long-term, whether HE could help, i don't think i'm able to accept help. there's also the consideration that i don't want to feel obligated to contact him in the case of any crisis. i just want to disentangle myself from all connections.
i don't know if i can wait a week and a half to tell him these and other things. should i write the letter?
thanks again for all the comments.
cb
Posted by estrellita on April 20, 2008, at 2:06:35
In reply to Re: should i walk away from therapy?, posted by CareBear04 on April 19, 2008, at 23:37:07
Seriously, girl, did you not read what I wrote to you? ;-)
Man, it sounds like things are so rough for you right now. I sense some ambivalence in your comments as far as whether or not to return to therapy (either with this particular therapist, or at all).
Can you go in for your regularly scheduled appt time this week, even though you already canceled? If so, I think maybe you should just go even though I KNOW you don't want to.
It's so weird to read what you're writing about this, because I've been through it and felt like the weirdest person because at least most other people who go to therapy...go. You know? And they talk when they get there. I was just asking an acquaintance (I walk her adorable dog) who has been a psychologist at a university campus for decades what I should do about my own "stuckness" with my current therapist. After I told her the backstory (of my depression, and of my relationship with this therapist as well as the past one), she told me she thought I should go back, try to tell him some of what I was telling her, and give it another chance.
She listened to what I was saying and, probably because of her years of experience, really got what my depression has been like - she kept referring to it as "biochemical." She made me feel like taking medication and going to therapy is what I need to do to stay healthy right now. And I know it's what has gotten me healthy in the first place, as much as I hate to admit that at times. I don't know about your cultural background, but mine is pretty anti-medication, anti-therapy, and all just-don't-be-depressed. So it felt good to hear her acknowledge how much this has felt out of my control. I despise the old diabetes/insulin comparison that every therapist and their mother seems to make, but it's true that realizing a good chunk of what I experience is "biochemical" is a reminder that it's not all my fault, that it's a health issue that I do need to stay on top of.
Maybe I'm reading too much into what you've written, but it sounds to me like some of that has been true for you, too. The way I see both your and my situations is that it's better for us to be going to an imperfect therapist (who is not actively harmful) than not to go to therapy at all. It's too easy for me to stop going, to get so tired of feeling like a patient and just stop in an attempt to feel "normal" (whatever that is). But my discussion with the psychologist friend of mine helped me see that being in therapy, taking medication, and doing things that help my mental health (eg exercise, eat decently, get sleep) is actually an active choice I'm making as an autonomous adult. For me right now, not going to therapy would be more of a passive thing that I'd be doing (well, not doing) for the wrong reason.
Also, I wonder if the fact that your therapist is a guy is part of the dynamic that you're experiencing right now. I think that has been the case for me. With female therapists, I'm more used to them being (or trying to be, haha) nurturing, gentle, and all that. When I've talked about quitting in the past, they seem to be more likely to try and talk me into continuing. Not out of any self-centered reason, but because they believe it's the right thing for me (and it usually is).
With my current therapist, however, when I talked about quitting and said "I'm done. I'm just done" about 15 times in one session, he didn't try to cajole or convince me. He took what I said at face value, and that was really disconcerting. I think that subconsciously, I wanted him to argue with me, to try to convince me to stay, to tell me that he could help. But he didn't. In fact, when I told him (the night before, natch) that I would come in at my regular time, he told me we'd have to move it to a little later because he had scheduled something else for that time.
I'm pretty sure that's not something a therapist would normally do, and I was really put off that he'd already penciled me out of his schedule. On the other hand though, it forced me to see that therapy is a choice I'm making - he might have an opinion about it, and he might believe it's helping, but he's not going to sit around and argue with me about coming back. I hadn't expected this sort of reaction at all, but I'm glad it happened. I think that, subconsciously, I was being manipulative in saying "I'm done" when in reality I was completely unsure as to whether I'd go back. The fact that he wasn't waiting around or begging me to return got me to feel like I really do need to take more ownership of decisions in my life, especially those that affect my mental health.
It's like that annoying saying about not hurting anyone but yourself. I think with therapists it can be hard to realize that it's about us - not really about them, or them and us. Just us. That's what we're in this whole messy thing for - to be better, to suffer less, to get our lives back.
For my session following the "I'm done" session, I wrote down some notes ahead of time and spent a little time visualizing myself talking about what I'd written with the therapist. I even tried to anticipate what he might ask me and wrote some notes on that, too. And, surprise surprise...the session went pretty well. I think I'm going to do the notes thing more often. (And for the record, he liked that a lot better than what I'd done the week before, which was email him 5 single-spaced pages in advance and then showing up and not saying anything.)
My therapist asked me why I kept getting so caught up in the structures, rules, etc of therapy - some of the stuff I wrote about was crazy, gender and power relations and all kinds of stuff that yes, is important, but not doing anything to help me gain control over depression and my life in general. It sounds like you're starting to do that a little bit, too - what with doing a cancellation, calling him about it, etc.
I have been there so many times, and it does make it feel like I'm making some kind of progress (whether forward, backward, sideways, or otherwise I don't know), but this therapist pointed out that maybe that's all a distraction. I ended up admitting that I'd rather fight a tiger (or something ludicrous like that) than talk about my feelings or about stuff that has been painful.
It's pretty clear why I was throwing all kinds of obstacles and hurdles in my own way. The weird thing is that I really was not conscious that I was doing it for that reason. I mean, I knew I was avoiding the discussion of emotions, but I wasn't ACTIVELY trying to sabotage myself. All that other stuff just started to seem important, and if he was unwilling to address all of that FIRST, then...I'm done. ;-)
So...does any of that help? Not trying to cajole or convince...well, maybe I am. :-)
What you wrote about wanting to disentangle yourself from all connections feels so familiar, yet it worries me when I hear it from someone else. I think we both know that's a sign you need to take better care of yourself, not worse. And it sounds like continuing to have a connection - any connection - with your therapist is just as important right now as the quality of the actual work you do with him. I urge you not to let that connection go right now.
My suggestion is to yes, write down your thoughts and frustrations and questions and worries, and take it to your next appt - ideally, as soon as you can get one. Maybe you'll find that you want to re-dedicate yourself to taking care of yourself, and maybe he's the person who can help you as you do that.
My dad is a strong believer in the idea that "things happen for a reason," and I like that he believes that. The therapist I'm working with now would NOT have been helpful to me in the past, but by the time I met him I was in a place where his help is just what I need. No coddling, just "if you want to do this, become better in these ways, I'm here to help. It's your choice." Do you think that could be true for you and your therapist now, if you continue to give it a chance?
Keep me updated!
*estrellita
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