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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by fallsfall on September 29, 2004, at 9:09:52
In a post above, Mair said:
>>...that I started out anyway as a prospective short-term CBT patient (that's a laugh now).
In my first therapy appointment, my CBT therapist said that she thought that I was depressed and that she would need to see me for 6 sessions or so.
8 1/2 years and 2 hospitalizations later I switched to a Psychodynamic therapist. He said that clearly I should be able to get back to work (I had been disabled for 6 1/2 out of the last 8 1/2 years), "maybe not by September, but soon there after" (This was late June). It is now 12 months *after* that September. I am working 10 hours a week, but neither of us consider that "working".
Over the last couple of weeks, he filled out a disability form for me, and had a discussion about changing pdocs (really, more changing medication philosophy), and said "You really aren't doing well".
So what is it that makes me give these (competent) therapists the impression that I'm an "easy" case, and then over time they figure out that I'm really a mess? Why is it that I am different from the typical patient, in that they assume that everything will proceed smoothly and I'll be "fine", but things don't proceed smoothly and I don't get "fine" (and in some ways get worse over time)?
Why should I believe my current therapist when he says "I know that you can feel better, we just need to do X, Y, Z"?
Posted by Daisym on September 29, 2004, at 10:19:28
In reply to Started out as a short-term CBT patient, posted by fallsfall on September 29, 2004, at 9:09:52
I can soooo relate to the being the "fairly easy" typical client who arrives in therapy with a boring list of "I'm unhappy with no real reason," "I don't handle stress like I use to," "my first child is leaving home in a few months and I'm not handling that well." He had me pegged for a midlife crisis and I agreed with him. Add in that those good communication skills and a lifetime of practice of hiding my true feelings...yeah, he got snowed. But I was snowing myself too. I didn't think I was such a mess, or maybe I didn't think this needed to be sorted out. Because I felt so different from the way I felt a year prior, I just assumed I needed to find the trail back, not find the trail out.
When I'm needy and demanding, I feel really guilty about how I started. I always wonder if he had known, would he have taken me on as a client? He says yes, that he does long-term trauma work, and that as a therapist you never know what you are going to get when you start working with someone. So I bet that is how your first therapist felt too.
I think we present as smart, articulate women who know enough about themselves that we look like we just need some direction and support to get things back on track. Plus, we have all these wonder drugs now that help "kick" depression. It is easy to forget that "knowing" the answer or seeing the solution doesn't mean you can take action towards success. Even more important, if you can force yourself to do certain things, like 10 hours, this doesn't mean you don't feel bad, or unhappy, while you are doing them.
As far as getting better quickly, I keep getting told that it took me 40 years to get to this spot, so why would it take 40 minutes to get to that spot over there...the one in the sunshine that I'm trying to reach. I struggle against this, "I should be better by now" demon every week. Part of it is longing to feel better, part of it is that need to be at the top of my class ALWAYS, even if it is my therapy class.
Why should you trust him? Because you do. It is as complicated and as simple as that. You might not trust his timelines (you experience tells you different) and you might not always trust that he has an answer, let alone "the" answer. BUT, you trust that he will help guide you and not leave you alone in the midst of all this. And you might not even trust this everyday. But overall, deep inside, he holds the hope of getting better, of healing, of feeling somewhat normal again.
It is OK to cling to that hope without concrete evidence. It is called faith. And it keeps us alive and fighting.
Keep fighting Falls. We need you. I need you.
Posted by Racer on September 29, 2004, at 12:29:31
In reply to Re: Started out as a short-term CBT patient, posted by Daisym on September 29, 2004, at 10:19:28
Yeah, I think Daisy's right. I think that most of us here -- a self selected group of people who communicate through words, after all -- are most likely to present as pretty together at first. It's only once our defenses come down that we can expose our real issues.
Here's the topic for the next thread: "Is the unexamined life worth living?"
For me, the answer is -- for some people, I suppose it is. I am not one of those people, which is as much a part of me as the large breasts or the bad vision. It's just the way I'm made. On the other hand, even in my current state, I can present myself as being in pretty good shape if you meet me face to face. (Although, I suppose I'd look a bit on the thin side. Even that, though, isn't all that apparent, since I wear the same tops that I wore 70 pounds ago. They're baggy enough to hide what I look like, unless you're really looking.)
So, which would you rather be: someone who could do 12 sessions of CBT and go on with your life? Or someone with the strength and courage to spend 9 years working hard to work out the underlying issues and resolve them fully, so that they don't haunt you -- and don't come back?
Personally, I know which looks more admirable to me, but it's a personal perspective.
Posted by deirdrehbrt on September 29, 2004, at 17:46:01
In reply to Started out as a short-term CBT patient, posted by fallsfall on September 29, 2004, at 9:09:52
Falls,
I think that Daisy hit it on the nose. You are articulate, intelligent, and don't come across as being ill when someone meets you. I can imagine that when you visit a therapist they too see someone who is reasonably healthy, and just in need of some small amount of guidance.
The same thing happened to me with my T. I first went there to deal with the gender issues and the break-up of my marriage. She had no idea about the rest of the crap that I'm dealing with until after the second hospitalization.
Sometimes, I think, they (therapists) are blinded by what they first see. Everything is filtered through the lenses of the first visit or two, until they are hit really clearly between the eyes with something that is clearly not what they had been anticipating.
Dee.
Posted by just plain jane on September 29, 2004, at 18:04:59
In reply to Re: Started out as a short-term CBT patient, posted by deirdrehbrt on September 29, 2004, at 17:46:01
and when they find someone deeper than their standard whinya$$ it may shock them. Some it will even scare the bejabers out of because, face it, some of the people working in mental health are NOT as intelligent or articulate as you, or, likely, even as deep.
Just like I find with a LOT of teachers these days, there are those who go for the degree(s) because thay haven't a clue and all pollyanna-like think they're gonna HELP THE WORLD one sad person at a time. Then there are those who are on a power/ego trip, those who thought they could make the big bucks and how hard could it be and bla bla bla
and so on.Then, there are the true counselors, who can't help but be a therapist or Pdoc. Cause their heart/soul/psyche won't let them be without it.
Gotta sort through the fruit stand to find the best fruit.
just plain .....
.....
.....
gimme a break, eh?
I'm tryin to remember...
Posted by fallsfall on September 29, 2004, at 22:49:57
In reply to Yep, they're expecting an easy time of it, posted by just plain jane on September 29, 2004, at 18:04:59
Thanks for your responses. They did help. I see him tomorrow morning, we'll see how it goes.
Yes, Daisy, I do have faith in him. I just feel a lot better when I have a clear plan in my mind... Maybe he can help clarify things.
Racer, "So, which would you rather be: someone who could do 12 sessions of CBT and go on with your life? Or someone with the strength and courage to spend 9 years working hard to work out the underlying issues and resolve them fully, so that they don't haunt you -- and don't come back?" Without a question I would rather be the 9 years person. I'm just afraid that I'll spend 9 years working hard and NOT resolve them and STILL have to deal with them. I guess I don't have a lot of faith that my ultimate prognosis is going to be good (his words were "guarded, but positive prognosis").
Dee, so if I don't come across as sick, why is it that I can't function??? Sorry, I'm just frustrated. It does help to know that I'm not alone.
Jane (yes, I believe that is the name you were searching for), When I was looking for my second therapist I asked my first one what she thought it would be important for me to look for in a therapist. She said "You need a therapist who is very smart", and that's all she said.
Thanks for the support, guys. Hopefully I'll be a little more optimistic after I see him tomorrow.
Posted by mair on September 30, 2004, at 8:33:19
In reply to Started out as a short-term CBT patient, posted by fallsfall on September 29, 2004, at 9:09:52
falls
I can identify with so much of what you wrote. When I went into treatment with a different T/pdoc about 10 years ago I started on this odyssey of one unsatisfactory drug trial after another and therapy that went no where. I got so I hated hearing about all the wonderful new miracle drugs and about how treatable depression was if properly diagnosed- I couldn't figure out what was wrong with me that neither drugs nor therapy seemed to adequately address. After awhile I stopped regular therapy because I had run out of insurance benefits and patience with the process and I guess by that point I was on a drug combo that, while not great, stabilized me somewhat.
I decided to go back into therapy a year or 2 after that because I was worried that I was leading the kind of life, mostly with my work, which was bound to trigger a relapse and I needed to try to restructure things to insulate myself. I also couched things in these terms because I wanted my T to refer me to someone else but I didn't want to hurt his feelings. He simply didn't do any kind of CBT. He referred me to my current T. When we first started working together, we were exclusively doing CBT and when I'd start talking about stuff in the past, she'd cut me off and tell me it was irrelevant to the kind of therapy we were doing. However, it didn't seem to take her all that long to decide that CBT wasn't going to fix what was going on, and I've been working pretty intensively with her now for about 5 or 6 years. (I've totally lost count)
I've always felt that I arrived on her doorstep under false pretenses, and I sometimes worry (alot) that she really wants to ditch me as a patient because I am so much more work and trouble than she bargained for when she agreed to work with me. She's spent countless hours trying to convince me that working with more longer term patients is more rewarding for her.
All that may be true, but what I've struggled with in therapy as much as anything is the issue of why I'm so hard to treat - why everything seems to take so long for me. I've never been sexually or physically abused, have little or no history of mental illness in my family and had a maddeningly boring childhood. It frustrates me some of the time and shames me nearly all of the time. All of the medical care I've gotten somehow feels self-indulgent to me without a real framework to explain ti and I've wondered whether maybe I just don't want to get well.
I liked what Daisy and Racer said about how we present. I've always functioned on a pretty high level and have always presented pretty well, I think. So I've always felt pressure to mask how I really feel. And although I don't believe in living the unexamined life, I'd trade the last 10 years of on and off therapy and only moderately effective drugs in a heartbeat for some more effective drugs and a few months of CBT, if it would have worked as well. Like you said, the idea of working so hard to figure things out is only appealing if you know it's all going to eventually work.
My T doesn't talk in terms of cures, but in terms of quality of life. And when I look at things over a longer continuum, I can see that there has been much improvement. And my T is very good at mapping out where we're headed and what we're trying to accomplish; she knows now that it's helpful for me that she periodically review our progress and why we're talking about the issues we are. I never knew any of this with my last T. She's also a very upbeat optimistic person, or at least if she's pessimistic about my future, she works to hide it. I decided awhile ago that as long as she felt I was making progress, it would be ok if I didn't always see that progress and as long as she felt optimistic about how far we could go, I'd just try to feed off her optimism. That helps, but I'd surely feel better if I could see light at the end of the tunnel. I don't obsess as much as I used to about how many years I've been in therapy (mostly I just try not to think of it), but I really don't want to accept being on a therapy for life track either.
Thanks for bringing this up.
Mair
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