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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 38. Go back in thread:
Posted by Dinah on August 4, 2004, at 11:43:08
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by pegasus on August 4, 2004, at 11:34:56
Oh, Pegasus, I'm glad you said that. My therapist thinks I should confide more in my pdoc, but if something doesn't have medication implications, I see no reason for him to hear about it.
I tell him about upcoming or past stressors, reactions to meds, problems that aren't being adequately addressed by meds. Anything else is none of his business. After having one pdoc who was too involved in my psyche, I resolved not to have that happen again.
My therapist thinks I'm being stubborn. My pdoc is clear that he doesn't *want* to hear about anything that doesn't affect my meds.
Posted by gardenergirl on August 4, 2004, at 19:12:49
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by lucy stone on August 4, 2004, at 10:24:43
Thanks for your thoughts. It occurs to me now that he may have been able to help with a referral to someone who might consider taking me as a professional courtesy. And I won't see her again until after he gets back, because the plan is to see her monthly. So I will have the opportunity to backpedal with her if my T and I think that's best.
And it does feel a bit like someone is messing with my head and my comfort with my therapy. I'm just such a "go-along-er" sometimes, that I don't speak up and think of disagreeing until later.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:17:15
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by B2chica on August 4, 2004, at 10:39:02
Hi sweetie, good to hear from you. It sounds like you have a good arrangement going on. That's great. I think what you describe is actually what I had in mind when I met with her. Somehow, I let her "putting the cards on the table" influence me beyond my normal way of approaching things. Because come to think of it, I even told her up front that I was interested in med management as I was quite happy with my T. Hmmm. I had a tiny feeling she was turning her nose up at his approach. Nothing she said overtly, but just a hint.
So glad your T passed test number 3. Sounds like my kind of T.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:27:40
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by DaisyM on August 4, 2004, at 10:49:31
> I don't know GG, anyone who told me these things in such a blunt way would make me nervous. How does she REALLY know how you are doing in a 20 minutes conversation? It seems to me that she is hearing the side of you that feels bad about how things are going right now (you've had a tough couple of weeks) and she is going to "fix" you.
To her credit, she did spend more than an hour with me. I was kind of tickled about that, because this is my first experience actually paying for mental health care. And it was pricey. Will apply to my deductible, but still. But I think you are right, she was taking a very problem-solving approach, which would fit better with CBT than psychodynamic. And I didn't try to hide my warts, well except for the one I haven't yet shown my T...So I probably did look pretty bad on paper.
> I'm not saying don't work with her, I just don't want her to make you doubt yourself and get more depressed. I think she has already done the first. I can't imagine why she would feel it necessary to tell you you are acting like a child. She might think that and suggest working on a "more resilient way of coping with marital fights" but still...She was awful quick to judge.Oh my goodness, I think you really hit on something here that I couldn't see. She DID make me doubt myself. I felt terrible about myself when I left. I even though, what's the point in upping my medication if it's just that I am an irresponsible, lazy bum? Although at one point, I did share with her that one of my big motivators was the avoidance of shame. So perhaps she felt the need to shame me? If so, ugh. We also talked briefly about tangible rewards or punishments, and we were talking major amounts of money. The thing that I could come up with that would be most aversive to me in order to motivate me was donating four figures to the Bush campaign. She jumped and said, "Let's not go that far!" So I do like that about her. :D
>
> I don't think your therapist will be upset with you. But he would probably question why you feel you need to work with this other person, beyond meds. Are you not getting what you need from him? Did she make you feel bad about certain things so you now feel you HAVE to work on them? Is there an underlying curiosity about her methods, or the fact that she is female?Well, I think he will admit that he can't give me this if I do indeed need it. But he doesn't think that's what I really need, or I would have figured it out for myself. And I think in some ways, he is right. But the transference thing is being triggered in that I am worried he will be disappointed in me. :(
>
> Just me thinking out loud here. Somehow I'm reminded of your old boss whose CBT orientation you argued with a lot, and your therapist shares your views (I hope I didn't get that wrong.) If it was me, I don't think I'd have a session with her until my therapist was back and I talked to him about it. If he thought it was an experiment worth trying, then I would proceed. (OK, I wouldn't but that is just me.)Yeah, I definitely am in the same camp as my T. I can't imagine ever saying something so blunt to a client. Not without a lot of warm and fuzzy and a solid relationship first.
> I should also caution that all of the above may be a bit strong because we've spent the last few sessions talking about how hard I try live up to my mother's expectations of me and how she would think the regression that therapy has brought on is ridiculous. She has always told me that I was too sensitive and moody, and that smart, strong women don't need therapy. They just need to plow through life and eventually everything gets better.
Oh, I hate that idea. There is still a little voice inside me that has this view, too. Not sure where I got it, except perhaps that I always had to be independent and solve problems myself if I wanted to be sure they were solved. Asking for and needing help still feels like weakness to me a lot of the time.
>
> Your description of this doc hit a nerve.
>
Sorry about the nerve. But your post really resonated with me. I think your take on it is right on the money. I'm glad that I don't see her again before I see my T. I feel a bit more confident about what I need and what I need to do.Thanks,
gg
Posted by gardenergirl on August 4, 2004, at 19:29:57
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by Poet on August 4, 2004, at 10:52:53
Thanks Poet. I'll be interested to hear the answer.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:31:40
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by pegasus on August 4, 2004, at 11:34:56
You know, more and more, I think an arrangement like what you describe is what I need. It's what I wanted going in. Just got sidetracked somehow by the force of her personality.
Yeah, I will see my T before I see her again. Just obsessing right now. It's what I do. :)
Take care,
gg
Posted by mair on August 4, 2004, at 22:11:03
In reply to Re: Good therapist-cop/Bad therapist-cop » pegasus, posted by gardenergirl on August 4, 2004, at 19:31:40
Maybe I missed something but how did it come about that you agreed to therapy with this woman anyway?
I see a pdoc periodically for meds management. Since i see her so infrequently, she asks me a lot of questions which seem like they ought to be coming from a therapist, and it makes me a little uncomfortable. Although I guess part of her evaluation is to review whatever symptoms seem to be plaguing me at that moment.
I did the 2 therapist thing for awhile, really at the behest of therapist #1 (a male) who thought I might be more comfortable talking about some issues with therapist #2, a woman. They worked in the same office. I think therapist #1 was hoping therapist #2 could do some CBT with me, which really wasn't his forte at all.
After awhile it was confusing in the extreme, because what each of them did with me wasn't different enough. Also, at some point they had a falling out and I felt sort of pulled between the 2. I don't think I'd go down that road again. Unfortunately, the experience ended up souring me on both of them, so that rather than having 2 therapists, I ended up with none.
As for her attitude - try to imagine how one of your own clients would feel if you proceeded to sum her up in the first session. I think we all like to think that we're a little more complicated and multi-layered, and that neither our problems nor the solutions are so totally transparent.
Mair
Posted by gardenergirl on August 5, 2004, at 8:17:49
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by mair on August 4, 2004, at 22:11:03
Thanks for your input. I agree, if I had said something like that to a client I would not be establishing rapport. I think that I just got kind of sucked in by the force of her personality. And I suppose the "wish" that there is something I can do to get well quicker.
Sounds like your experience was, er a learning opportunity? :) Thanks for sharing it.
Take care,
gg
Posted by Poet on August 5, 2004, at 18:16:16
In reply to Re: Good therapist-cop/Bad therapist-cop » Poet, posted by gardenergirl on August 4, 2004, at 19:29:57
Hi GG,
My T said that if I want to start therapy with pdoc that I could still see her monthly or on as needed basis. She wanted to get into why I thought I wanted to see him more, but I told her that it's something that I'm just wondering about and not ready to do it.
Poet
Posted by antigua on August 5, 2004, at 18:57:07
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
Well this is kind of funny. Overkill, maybe. I have a Pdoc and two therapists. My Pdoc is meds only (bi-monthly or monthly) but he likes to check in on how I'm doing. He focuses on my ability to function as well as possible in life--his goal is to make me feel GREAT, he says, and not just be surviving. I'll believe that when it happens.
T #2 is my EMDR therapist. Sometimes we just talk and don't do EMDR at all. She's o.k.; her view differs a little from other T, but I mostly use my time w/her to let EMDR open up my emotions.
T #1 leads all of the others. She is in total control. I defer to her because she knows me best. She always "reframes" what the others said, based on what she knows about me.
The other difference is that I'm only attached and emotionally invested w/T#1. I don't need any more complications in my life.
Actually, this is all working out quite well. Expensive, but it's going well.
antigua
Posted by gardenergirl on August 6, 2004, at 20:05:01
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by Poet on August 5, 2004, at 18:16:16
Thanks for passing this on. I bet I'll have to get into why I felt like agreeing (whether I stick with it or change my mind) with my T.
Take care,
gg
Posted by gardenergirl on August 6, 2004, at 20:06:20
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by antigua on August 5, 2004, at 18:57:07
Wow! I'm glad it's going well. The first thing I thought of when I read your post was "how does she keep everyone straight?" But I bet it's not that hard. And it also sounds like everyone understands their individual roles. And it certainly does sound expensive.
Thanks for sharing your experience.
Take care,
gg
Posted by gardenergirl on August 6, 2004, at 20:11:04
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by antigua on August 5, 2004, at 18:57:07
How can I tell her I changed my mind without looking like a total flake? And why do I care if I look like a flake to someone I just met? In some ways, I feel like there is instant transference going on...which feels odd. Am I just really into passivity or people-pleasing right now because I'm more depressed? Sigh, I wish my T were here....(Now why did I really want to type "I wish my brother George were here" and put up a candlabra on a grand piano?) :D
gg
Posted by Dinah on August 6, 2004, at 23:00:51
In reply to So, suppose I want to change my mind....., posted by gardenergirl on August 6, 2004, at 20:11:04
Your therapist is coming back before you see her again, right? Once you discuss what she said with him and get his reaction, you'll know better if there are any "rules" from your therapist and how he'll feel about it.
I'm always upfront with any adjunct therapist I see that my therapist doesn't allow dual therapy. If your therapist doesn't either that should solve your problem. On the other hand, biofeedback guy was real nasty about my therapist not allowing me to have two therapists at once. Of course, biofeedback guy was nasty about everything.
Posted by gardenergirl on August 7, 2004, at 0:21:38
In reply to Re: So, suppose I want to change my mind..... » gardenergirl, posted by Dinah on August 6, 2004, at 23:00:51
Thanks, I am looking forward, sort of, to talking with my T about this.
Do you suppose there is a biofeedback location for nastiness? Perhaps that T could use some work? :)
Take care,
gg
Posted by mair on August 8, 2004, at 15:51:48
In reply to Re: So, suppose I want to change my mind....., posted by gardenergirl on August 7, 2004, at 0:21:38
Didn't you just meet with this woman once? Also, I don't recall that you went into see her with the idea of having an adjunct therapist - I thought she's the one who raised it?
I don't think we should ever have to totally own decisions we make when we're put on the spot. Life is all about further reflections.
Mair
Posted by Joslynn on August 9, 2004, at 22:59:46
In reply to Re: Good therapist-cop/Bad therapist-cop » mair, posted by gardenergirl on August 5, 2004, at 8:17:49
Sorry I am late to this. Gardner Girl asked: "For those who see a pdoc and a T, how does it work for you? Any conflict between the two?"
Yes I see both a pdoc and T, and unlike some situations, my pdoc also does therapy with me. I see my T every other week for therapy and my pdoc once a month for med check & an hour therapy.
How it works: I talk to them about very similar things. Since I am single, and a lot of my situations involve the, er, challenges of dating, I like to have both the male and female perspective. My pdoc is a very kind person who is somewhat protective of me in the way he asks questions about someone I am dating. Sometimes, as a man, he will call a another "guy" on his behavior when that guy is not treating me well in a way that my female therp may miss. It's hard to explain.
You know how sometimes, your guy friends or brother will ask questions of whoever you are dating in a protective, big-brother kind of way? It's sort of like that.
My female therp, on the other hand, is great at making me realize the options I have and reminding me that I am a survivor and will continue to survive. She helps me stay out of catastrophizing and fantasizing. But sometimes, she misses little things about men in my life that the male pdoc picks up on. My therapist also has a more confrontational style (in a tough love way, which is good) whereas my pdoc is more reflective of how I feel.
As far as I know, they don't talk to each other about me (shocking that I am not a case of constant fascination to them!), but they both have each other's numbers. My pdoc told me to tell my therp that he wants her to call him if I seem to be "slipping," if that is ok with me, which it is. So far, I don't think she has made a call like that.
What is nice is, if my therp is on vacation, I can call my pdoc, and vice versa. I don't have many crises where I feel the need to call them, but the few times crises have occurred, they have always happened when one of them has been on vacation!
My pdoc saw me firsthand when I was in a very severe depression and he was by my side through the first weeks of that. So, I don't think I could just use him for meds and see my female therp just for therapy.
I feel that because he saw me at my worst and helped me through it, there was some sort of "imprinting" there, like the goslings do, and I still like to see him as well as my therapist. (I went to her a few weeks after the height--or rather, low?-- of the severe depression.)
Sometimes I will talk him about a comment or theory she had about something or I will talk to her about something he said, usually about meds or something like that.
I would not give either of them up and I think that both of them enhance, rather than detract, from each other.
That said, I think it was not nice or effective for your new pdoc to say you were acting like a child! Especially when she was just in the "intake" phase. How can she even know you well enough to even say those things? Plus, there are better ways to communicate!
But if she has tips for procrastination, do share!!!
Posted by Joslynn on August 9, 2004, at 23:07:14
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by Joslynn on August 9, 2004, at 22:59:46
Forgot to add: The closest that it came to a conflict was in the early days, when I was still in a very idealized transference with my pdoc. (Since then, he has slipped from his pedastol a bit, though I am sure there is still transference without a doubt.) Anyway, she said, "Be careful not to idealize him." That made me feel a bit defensive.
I'm sure she is right that I idealize him, but telling me not to do that just made me feel censored in a way.
I think that is the only time I felt kind of torn about having them both. I am sure I do idealize him more than her, but I think that is simply because I have a good relationship with female friends, my mom, etc., but I have not had a good track record with romantic relationships and my Dad was impaired in his parenting because of alcoholism.
So I think the idealism may be because I am simply not used to that level of kindness and attention from a man. Of course, that compassion is paid for and I do want to find a form of that from men in my "real life," in a realistic setting.
Posted by gardenergirl on August 10, 2004, at 3:03:32
In reply to oh yeah..., posted by Joslynn on August 9, 2004, at 23:07:14
Thanks for sharing your situation. It's nice to hear from so many that they wouldn't like being told what she said, either. It sounds like you have a really good arrangement. I'm glad that is working for you. And I love your "imprinting" metaphor. That's great!
Sigh, about idealization...yeah, that *is* a defense mechanism, but it often is a key part of transference. And heck, when you mention an alcoholic father, it certainly comes to my mind that most of those I idealize are male. Perhaps that's why I reacted so strongly to this woman...maybe she's the mother...Hmmm. But I think you have to have some of this in order to work through it. I suppose your T was cautious maybe in part out of some countertransference, but also because she's not in the room, and may not realize how it may be helping???
Take care,
gg
Posted by gardenergirl on September 6, 2004, at 3:46:49
In reply to Re: oh yeah... » Joslynn, posted by gardenergirl on August 10, 2004, at 3:03:32
I saw my pdoc for the second time on Friday. I can't remember if I posted all that happened in the month since I first saw her and she said I was acting like a child. Let me do a quick summary.
She upped my Nardil to 75 mg. This made me very very restless and agitated...like I was going to jump out of my skin. Goodness I HATE that feeling. Always have ever since I was a kid and had to take asthma medication periodically that had adrenaline in it. Yuck! So, call number one to her is returned within a couple of hours, from her home. She had me take the Nardil down a half a pill, which got rid of the restlessness.
Then I developed terrible insomnia, the early awakening kind. For some reason, no matter what time I went to bed, I could only "sleep" 4 hours at a time. I would get up and try some tea or exercise or something, but could never get back to sleep. After about a week like this, when the effects of losing so much sleep were really getting to me, I placed call number 2. Again, she returned it quickly. (I wonder if she always does this, or if she is skittish about the Nardil...?). She started me on Gabitril for sleep.
This (or maybe just the Nardil) caused a significant amount of edema this past week. My legs looked like over stuffed sausages, my hands and face were puffy, and I was incredibly fatigued and at times short of breath. I gained more than 10 pounds of fluid in a few days. When I got on the scale at one point and saw a certain weight I never in a million years EVER thought I would see, I just cried. I would have called her again, but I knew I was going to see her Friday. I quit the gabitril because I don't know if it was really helping with the sleep or if I was just adjusting to the Nardil dose finally. I also dropped back to 60 mg Nardil, which is where I started when I went to see her!
Okay, so I wallk in all nervous about how it went last time, and feeling like such a high-maintenance client since I had to call her twice, and would have called her a third time if my appt. weren't so soon. She agreed with me that it has been a rocky month and commented that I am medication sensitive. She proceeded to tell me about some new research that might explain this, which was cool because she was talking to me more like a peer. She agreed with the choices I had made to fix the edema, which worked, by the way...nothing like gaining and losing more than 10 pounds in one week!
She also talked to me a bit more about my mother, because I had mentioned that I had just seen my mom for shopping, and that may have triggered some depression this past week. She was very insightful about this, and really listened to me. She noted when I mentioned that my family of origin was Finnish, that a light box might help (it's very dark in Finland, and there is a high prevalence of depression...light boxes seeem to help there). We also talked about what I might try if I ever need or want to go off the Nardil. (Imipramine is what she mentioned.) But she agreed that now is not a good time to think about changing meds given the experience I had and since I am starting a new training job in a few weeks.
So, bottom line. She did not do CBT related stuff with me. It was more dynamic. I told her I thought I would just do med management, but that my T was okay if we were to do an adjunctive type of therapy, such as CBT. She seemed to downplay the two T thing again. I also told her that I really didn't like her when I left last time because of what she said, and she apologized! Wow! I also told her that although it felt like getting smashed with a two by four, it did have some therapeutic value. We also talked about physical and emotional sensitivity, and she seemed to really "get" this, too. Hmmm, was she a pod person before? Or is she now?
So I see her in a month, mostly because the meds thing was so rocky last month. But I feel much better about things. I probably will try to steer her more towards meds and physical stuff if she continues with Mom stuff. Although hearing it from another perspective was interesting.
Sorry so long. It's late and I have insomnia, so brain is a little disorganized.
Thanks again to all who gave me support and input. It was very helpful at the time. By the way, my T wondered if my need to call for pdocs was related to him leaving, since I did it same day. I suppose. But I really thought it was just that I finally got around to doing it. That silly unconscious!
Warmly,
gg
Posted by Aphrodite on September 6, 2004, at 8:01:50
In reply to Update on pdoc situation (longish, sorry), posted by gardenergirl on September 6, 2004, at 3:46:49
Wow, what a rocky month for you! I've mentioned before that I am not on meds but am going to a pdoc for the first time in a couple of weeks. I'm quite anxious! I am afraid that while treating the underlying instability in me, medication will just bring about another set of problems. Perhaps the therapeutic value of medication is to distract you from what was wrong in the first place? I mean, if I gained 10 lbs of water weight, I'd have a whole new reason for depression!
I thought it was awesome that you were able to tell her how you felt about her insensitivity last time! Starting off like that, I'm sure, will cause her to always choose her words carefully in the future. It sounds like you like and respect her more now, which is great. She sounds like she comes up with out-of-the-box solutions such as the light box, that she is really deliberating over you.
I'm sure there was connection to your T leaving and calling the pdoc. It gave you time and the impetus to continue working on your well-being. I'm glad she's willing to do some therapy with you too. I guess I don't fully understand the "only one T" rule -- I think two (or three, or four) heads are better than one. Why not get all the help you can?
I hope the meds start working for you soon. I'm glad you gave her a second chance. Sounds like it was worth it!
Posted by Dinah on September 6, 2004, at 10:11:35
In reply to Update on pdoc situation (longish, sorry), posted by gardenergirl on September 6, 2004, at 3:46:49
I'm glad it went so much better this time! And good for you for speaking up. :)
It sounds like it's been a heck of a month. And you've been so stoic! I'd have been whining like heck. So you're going to stay where you are, meds-wise? Nardil at the dose you started?
It wouldn't surprise me at all if there were some connection between the time you called her and your therapist's absence. I have a tendency to do that too. I think I want to make sure I have some depth in my support team. That's one reason I hope my pdoc never releases me to my internist like my headache internist did, despite the fact that we rarely change meds.
I would never go against my therapist's prohibition about having two therapists, but if my pdoc or adjunct therapists had interesting input I don't think I'd make a big deal about silencing them, although I wouldn't of course encourage them. ;)
Perhaps she it is her experience that first time clients need a "hook" to keep them tuned in and coming back. Shock therapy. And when you let her know it wasn't helpful, she changed tack. That way she wouldn't be a pod person either time. (And as you told her, to some extent it worked.)
Posted by Dinah on September 6, 2004, at 10:15:38
In reply to Re: Update on pdoc situation (longish, sorry) » gardenergirl, posted by Aphrodite on September 6, 2004, at 8:01:50
Aphrodite, a combination of meds that's right for *you* is a wonderful addition to therapy. While meds trials can sometimes (though not always) be unpleasant, so can leaving intense anxiety and agitation untreated. I'm really happy with my combo of average dose Klonopin and micro dose Depakote, with the less than a dozen a year "as needed" Risperdal for when I feel really really bad. Although I'm still depressed from time to time, to me it's a good compromise between medicating and not medicating, and it made therapy more effective, not less.
Posted by shrinking violet on September 6, 2004, at 11:00:51
In reply to Re: Update on pdoc situation (longish, sorry) » gardenergirl, posted by Dinah on September 6, 2004, at 10:11:35
I'm glad things are going better, GG! I'm sorry, I must have missed the original post, but I'm happy that you got everything straightened out, and feel more settled with everything.
Be well.
Peace,
-SV
Posted by Aphrodite on September 6, 2004, at 11:38:41
In reply to Re: Update on pdoc situation (longish, sorry) » Aphrodite, posted by Dinah on September 6, 2004, at 10:15:38
You're absolutely right, Dinah. If the meds work, it could bring great relief, and I'm willing to try. My fear, though, is that I am in such a bad place right now that I feel I cannot afford any negative disruption. It seems lose-lose to me right now. :(
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