Posted by fxckfeelings on November 8, 2012
Although stopping long-term intensive psychotherapy can leave you in a state of mourning and fear, particularly if it occurs during tough times or against your wishes, it’s unrealistic to expect that returning to therapy will make everything right again. Instead, give yourself time to adjust to change and reassess your ability to stay functional and positive. Then, if you think it’s necessary, find a therapist who’s a good, supportive coach and use him or her for a different kind of therapy that keeps your head straight without stirring up your deeper feelings. If you’re certain that you have to be “in therapy” to get helpful support and are helpless without it, then the therapy you’re in is helping you a lot less than you think.
–Dr. Lastname
In my early 20s I spent 4 years in therapy (which I think in and of itself says a whole lot about the not good place I was in my head). Therapy ended, not because I was ready, but because I moved. I am now 46, and in the years since I continued to work through a lot of things on my own, with my therapist’s voice in my head, if no longer in actual therapy sessions. In January my grandmother took a turn for the worse, with both health and cognition, and we had to place her in full nursing care. She has always been one of the most influential and positive forces in my life, so I had a hard time dealing with this. It sent me spiraling down into my 4th lifetime episode of depression. I’ve started back on Prozac, which I now realize I need to stay on for the rest of my life to try to prevent future recurrences, and I’ve spent the last 10 months in therapy with my former therapist via phone sessions as we now live 1,000 miles apart. I have finished working through a lot of stuff in that time, meaning I’ve changed my attitudes and perceptions and behaviors, which has changed my life, inner and outer. I wish I’d figured it out 25 years ago, during that first round of therapy, but better late than never. It’s been a hard year. My grandmother died 7 weeks ago. The grief hit me more than I ever imagined. I thought I’d prepared in those months when she was slowly dying, but I was wrong. What is the saying—Where there is no struggle, there is no strength? Good growth has come of the pain—I have returned to college, and I am training for my first full marathon in January. I am at a truly good place in my head and was ready to end therapy, so two weeks ago, with my therapist’s blessing, I had my last session. I knew, though, that ending therapy because I am truly ready is a celebration, but that it would also be a loss. It is currently hitting me harder than I imagined. How do I get through this and find a place of healthy acceptance of this transition?
While it’s unfortunate that stopping intensive psychotherapy after many years is hitting you hard, it’s not surprising. As you well know, loss is painful, be it the death of a loved one or the end of a source of support.
That said, your pain doesn’t mean your psychotherapy has been less complete than you thought or that you stopped it too soon, just that you can be a solid, resilient person and also be very sensitive to loss, both because of temperament and circumstances. WAIT! There is more to read… read on »
Posted by fxckfeelings on June 23, 2011
If treatments were always beneficial, and people were always rational, and life was always fair, it would be easy to figure out how much help a person needs. Unfortunately, treatments often poop out, and people often embrace or reject treatment for the wrong, often irrational, reasons, and life is just a cruel mess. So deciding how much real, imperfect treatment to use in real, imperfect situations requires courage, acceptance of your limitations (and those of treatment), and the conviction to tell the unfairness of the world to go fuck itself, you’re going to keep trying, anyway.
–Dr. Lastname
Although I’m usually a big fan and praise your blog endlessly, this recent post [“Helping Head,” 6/17/11] isn’t a “like.” Eating disorders are treatable to full remission. In fact, the pervasive idea out there that people just struggle endlessly and that treatment doesn’t really work is self-fulfilling and even dangerous. Please consider re-considering. There’s new science on this!
Without irony, I can say that treatment for eating disorders is effective. In other words, I agree with you, except that the word “effective” has a hook in it.
“Effective” is the word most favored by drug companies because it implies no guarantees, solutions or cures, just that the treatment in question produces results that are better than no treatment at all.
Unfortunately, it does not mean completely effective, or effective for everyone, all the time. (And it also may cause dry mouth, constipation, etc., etc.). WAIT! There is more to read… read on »
Posted by fxckfeelings on August 30, 2010
Someday, people with psychiatric problems will get safe, effective treatment without having to make difficult choices, and Thanksgiving dinner will come in a pill, and jetpacks will be available cheaply for every man, woman and child. For now, the state of the art is much better than it’s ever been, but it’s still primitive, and it certainly isn’t inexpensive. Until the silver bullet for curing mental illness is found, patients have to make innumerable tough decisions for themselves, weighing everything from side effects to costs. Or they can just bide their time until their jetpacks arrive to make everything better.
–Dr. Lastname
I decided recently to listen to my friends and family and see a psychiatrist about my depression, but I don’t know whether I’ve made the wrong decision, or whether I’ve just chosen the wrong doctor. Basically, I decided to get help because I feel helpless, but my doctor wants me to do a lot of the work myself and doesn’t really help that much. It’s not just he wants me to ask myself a lot of questions (and answer them—if I had the answers, would I really be paying him?—but also deal with my insurance company and read up on the medication he suggests (he tells me about them, sure, but he says I owe it to myself to read up on them on my own, and that doesn’t make sense to me since he’s a doctor, knows everything about the pills, and he could just tell me himself). My goal is to figure out whether therapy is worth it, or whether I’m just getting help from the wrong source.
I hate to sound like your psychiatrist, but ask yourself what you have a right to expect from treatment, given what you know about its limits and your resources for paying for it.
If you want, you can spin things positively by saying that you’ve heard about good new treatments that can really help and that you’ve got great insurance that you pay a ton of money for. Of course, you’d probably be full of shit.
WAIT! There is more to read… read on »
Posted by fxckfeelings on July 19, 2010
Today’s post tackles a common, yet heretofore-not-submitted question about therapy, namely, how to find good help without breaking the bank in the process. While it’s a simple question, the answer isn’t, so we’ve dedicated the entire post to helping those who want help with their mental illness, but don’t have a dime to spare.
–Dr. Lastname
I’ve been depressed for some time and could use some treatment, but my insurance has a big deductible, so I’ll be paying everything out of my pocket, which isn’t deep. My goal is to get treated for the least amount of money.
I’ll assume from your tone that depression isn’t making you suicidal or putting you at immediate danger of losing your job and/or family because, if it is, you need to forget about the cost of treatment and value the cost of your survival.
If depression is putting your life/work/family in danger, get a psychiatric evaluation, in an emergency room if necessary. Do not pass go, do not collect $200 (no matter how much you need it).
If that isn’t the case, there’s lots you can do to reduce the amount of money you spend on treatment…if you’re willing to spend some time, do some research, and use your common sense.
WAIT! There is more to read… read on »
Posted by fxckfeelings on May 3, 2010
Poor, well-meaning, dedicated therapists and the patients who love/destroy them. After all, it’s enticing to let someone persuade you that you’re their guardian angel and the only therapist that can help. It’s a fun ride for everyone, at least until you realize that you’re responsible for something you don’t control, and they’re even less responsible than before for dealing with reality as it is. While this is a shrink-based site, we are the first to admit that therapists are not perfect people, especially when they get in in their heads that they actually are.
–Dr. Lastname
I have a 30-year-old patient whom I’ve been seeing in weekly psychotherapy for 6 months and he had a terrible history of sexual and physical abuse and years in state care. Amazingly, despite all his trauma and several prior failed treatments, he settled into a trusting relationship with me. He tells me I’m the first person he’s bonded with, and he’s been able to stop using cocaine, and, for the first time, sees some hope for himself. The problem is that he just got a new job, and I’m not covered by his new insurance plan. He wrote me a letter telling me how much he feels his recovery depends on continuing the treatment we’ve started and I feel professionally obliged to put his welfare ahead of my financial needs, but I’d like to get paid. My goal is to do right by my patient, and not trigger the feelings of abandonment that underlie much of his negative behavior, but I’m not sure how long I can afford to see him for nothing.
There are many therapists who believe the best thing you can do for a troubled patient like this is to “be there,” providing the steady acceptance and secure relationship that they need for healing. I’m not one of them.
The sad fact is that the healing power of currently available treatments is vastly over-rated and a good example of false hope and the harm it can cause.
WAIT! There is more to read… read on »
Posted by fxckfeelings on April 15, 2010
While Shut Up! Week began with us doing the up-shutting, it concludes with the more fun exercise of instructing others when they can utilize their own “shut up!” skills. After all, a friend might want to help you, or you might want to help a friend yourself, but sometimes the best thing you can do to help someone is get them to keep their mouth closed. And with that, Shut Up! week shuts down.
–Dr. Lastname
For years, I’ve talked to a friend of mine about my problems who’s also a counselor, and during that time, he’s urged me to seek professional help. I used to brush off that advice, mostly because this friend lives in another city and only ever really talks to me on the phone when I have problems, but in the last few months, I’ve begun to consider taking his advice. I don’t know what to say when I call to make the appointment, however, because I haven’t the faintest how to explain the unknown in my head (which is the main issue that frustrates me). I want to scream, but don’t know why or what. Do you have any advice as far as how to ask for help when I’m not sure what I’m really asking help for?
Remember, funny feelings in your head cause fear, which causes funny feelings, which cause fear, which create a spiral that will flush you down the toilet of needless worry. The first thing to do then is shut up and think about whether you need help.
If you’ve had funny feelings in your head for years, they’re not about to kill you; they’re not telling you to kill yourself or anyone else, and they’re not annoying you to death. WAIT! There is more to read… read on »
Posted by fxckfeelings on September 14, 2009
The not-MD here: Now that an actual health care bill is almost upon us, I thought this would be a good opportunity to ask my writing partner, as an actual health care provider, for his take on how we can improve health insurance.
We don’t like to get political, and everyone’s entitled to their own views (at least I think so—he’d probably tell you you’re just wrong), but this is not an entry about politics; at its core, the health care debate is about health care, and as a doctor, not a Democrat or Republican, this is his medical point of view. We’ll return to normal cases on Thursday.
–Dr. Lastname
One thing you learn as a parent is that there’s never enough time, money, or resources to provide perfect safety and security for your family. Worse, if you hold yourself responsible for providing it, you’ll go nuts the first time something goes badly wrong and you can’t control it. You’ll blow everything on something that can’t be helped, feel like a failure, and have nothing left, financially or emotionally, for those who need you.
As such, compromising on how you spend your resources is as much a part of good parenting as is nurturing, although it often makes you feel terrible. So it is with health care systems.
Democrats sometimes emphasize the nurturing part of this process, our shared humanitarian desire to provide more care, while Republicans sometimes emphasize the tougher part of this process, our desire to make sure that treatments work and are well delivered. But at the heart of good management there is always an unavoidable need to make good compromises, and that’s what I think needs more attention and reform. Not fewer denials from the insurance companies, but denials that are more fair and decided upon more ethically.
WAIT! There is more to read… read on »
