Psycho-Babble Psychology Thread 997738

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conflicts seeing pdoc for psychotherapy

Posted by g_g_g_unit on September 24, 2011, at 7:40:48

so I have a pretty long, conflicted history (for anyone who doesn't frequent the med board) - dx'd with OCD at 19, major depression at 23 .. unfortunately, unresponsive to most treatment efforts .. then discover, through personal research, that I have ADD after immigrating with my family - see 3 pdocs before one finally agrees ..

initially, I'm terrified of this guy - he's an authoritative, older male in his 60s. I feel like I'm in military camp or something, and am literally quivering while I relate my symptoms to him. he then agrees with my hunch, prescribes dexamphetamine and I'm suddenly overwhelmed by a 'love' for him which remains relatively uncomplicated for the first few weeks of treatment.

unfortunately, I have a bad response to the dex - it causes a resurgence of my OCD - and we try some other stuff to treat the depression/anxiety without much success so far. he also recommends I enter psychotherapy with him after describing my situation at home, conflict with my parents etc.

so far, it's been 5-6 weeks of psychotherapy and I'm just growing increasingly angry and resentful with him. it began, I think, after I was describing problems with anhedonia/amotivation on Lexapro. he put a spin on it (asking why I can't act as my own "agent") that made me feel like I was being unfairly burdened. since then I've just been stuck in limbo - not responding well to Lexapro - and wanting to discuss medication, but then getting side-tracked with psychotherapy stuff and feeling like my will is being thwarted by his.
I feel trapped, and will always leave completely frustrated and desperately waiting for the next appt. so I can try and 'fix' our relationship but never completely having the courage to voice my complaints because I don't want to hurt his feelings. I am also very hung up on wanting to actually improve my *acute* functioning through meds, because my quality-of-life is so dismal right now.

last session I described rage towards myself and family and he read my mind because he asked "can you describe the anger you feel towards me?", even though I've been nothing but polite and emotionally contained in our meetings together. I voiced some complaints - mostly fantasies about how I feel like he likes his other patients better than me, wants to abandon me, etc.

he stays pretty unflappable and objective, which I like, but I just can't deal with this mounting frustration. I keep thinking if I try to talk more about meds, he'll peg me as compulsive and cut me off (which has happened before with another doctor) or suggest I just learn to cope with my symptoms through therapy. ughh, I know a lot of this is irrational, but I'm having a hard time separating my projections (particularly in dealing with other docs) from the reality of him. he ended our last session by saying that I can't just live at the behest of others (including him), so maybe he'll be open to negotiation, but I feel like unless I get what I want (meds), I don't wanna indulge him by baring myself. I donno if that's childish .. I hate this .. I kinda feel more enmeshed and distressed than before meeting him because I respect (and fear) him too much to pull my usual disappearing act when things go awry with pdocs.


 

Re: conflicts seeing pdoc for psychotherapy g_g_g_unit

Posted by sleepygirl2 on September 24, 2011, at 21:07:40

In reply to conflicts seeing pdoc for psychotherapy, posted by g_g_g_unit on September 24, 2011, at 7:40:48

This sounds difficult. I'd say push through with your thoughts about your meds. However your Pdoc responds you have concerns right?
Trying to protect Pdoc? I do that.
I find it difficult to manage the supposedly "objective" world of meds with the more "subjective" realm of therapy and related stuff. I don't know how pdocs do it.

 

Re: conflicts seeing pdoc for psychotherapy g_g_g_unit

Posted by sigismund on September 25, 2011, at 2:40:05

In reply to conflicts seeing pdoc for psychotherapy, posted by g_g_g_unit on September 24, 2011, at 7:40:48

>e put a spin on it (asking why I can't act as my own "agent")

I remember you mentioning it.

Why would you be expected to know? Is there some suggestion you should be able to act as your own agent?

Should you have said 'I'm not myself'?

 

Re: conflicts seeing pdoc for psychotherapy

Posted by violette on September 25, 2011, at 17:42:59

In reply to conflicts seeing pdoc for psychotherapy, posted by g_g_g_unit on September 24, 2011, at 7:40:48

Hi ggg,

Sorry to hear you are still trying so hard to feel better and take charge of your life. And that the dex didn't work. And that the Lexapro sucks...

I think your combination of anxiety, OCD, depression, ADHD sum up to what is known as emotional dysregulation. Even lack of motivation, or maybe it's what people here refer to as ahedonia - is often an impulse control issue. Your impulse to 'not do' overrides your desire 'to do'. Since you have a history of extreme anxiety (esp of the type that can be considered adjustment disorder), motivation problems could also be a form of depersonalization.

Do yourself a favor, and instead of piece mealing your dx and symptoms for treatment - look at it as emotional dysregulation. You could be inadvertently delaying your recovery by giving so much weight to all those individual dx's. You probably had an insecure attachment as a child as well. Take all this with a grain of salt; i am no expert.

It sounds like you have developed an intense attachment with this T-Doc, and that you are experiencing a lot of transference. Is he an (real) analyst? If he is, you would be better off telling him exactly how you feel about him. The kind of transference you are expeiriencing, in combination with your high level of insight, can make for really good therapy, imo. And much of the focus for discussion in your therapy would probably be the feelings that arise in your transference and real relationship with him. If you tell him what you're feeling, he will help you seperate your projections from what is really going on in the room...as you mentioned you were having some troubles sorting through those things.

The fear...i understand. You can minimize, though..instead of saying - you seem like a controlling jerk! for example, you can start by saying i feel intimidated by you..or you seem really 'strict'...or something like that to begin with.

"I feel trapped, and will always leave completely frustrated and desperately waiting for the next appt."

I think it's really important to tell him what i quoted above, and the feelings that are coming up; by doing so, you might feel some relief. Plus, if he is an analyst, you can pretty much tell him anything and he wouldn't even blink an eye anyway. The more truths you reveal, the better outcome for you.

My therapist is a Pdoc too. I had always put off talking about meds because it seemed to take away from our connection and our therapy work in general. Don't have any solution for that other than to build up courage slowly to tell him how you feel. I didn't make an issue out of my meds..i would think of it outside of session and just go in and ask him for a new one. Although how you interact regarding medications is part of the therapy too. But lucky for you, he is older and probably not hung up on medication rules like the younger doctors. I find that the pdocs over 60 are liberal with meds and more open minded, just try to help you relieve your symptoms without getting hung up on controlled substance issues for people like you who don't even have addiction problems.

Now that i think of my own experience with this, i used to wait until the end of sessions and just ask T-Doc, can you rx me __? And i would walk away with the script. I felt like discussing meds at the beginning of sessions 'wasted' the sessions. lol

I really hope things work out for you ((((((ggg)))))) you are stronger than you think, good luck :=D

 

Re: conflicts seeing pdoc for psychotherapy

Posted by emmanuel98 on September 26, 2011, at 20:59:30

In reply to Re: conflicts seeing pdoc for psychotherapy, posted by violette on September 25, 2011, at 17:42:59

My p-doc was also my therapist for six years. He was a great therapist and a great p-doc. Sometimes the combination can be great. He knows what you feel and is assessing it both in terms of biological and psycho-social issues. I think too many p-docs focus exclusively on the biological issues and don't bother with all the messy interconnectedness of being human. I feel grateful to have found a p-doc who loves to do therapy.


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