Twitter: Open Discussion

Suppose your therapist is on twitter and the account is public and the knowledge that the patient visits the twitter is openly discussed in sessions as the account is a top google result for the therapist’s name. Neither party has linked their account (following) to the other’s account for obvious boundary reasons. But the therapist is aware the patient reads it from time to time. If said therapist writes a hilarious tweet what are the ethical and boundary issues of the patient retweeting that tweet?

I am of the opinion that it would be a boundaries issue despite the public nature of the tweets and even if the patient did not reveal information about the therapeutic relationship. It would be an uninvited entrance into the therapist’s life outside of a session. So I would not re-tweet said tweet no matter how hilarious it is.

Obviously friending a social media account is off limits but there is a fuzzier area when it come to non-reciprocal friending sites like twitter where relationships may be more one sided. The formality of the communication put out by the therapist is also a factor.

For example it is fully acceptable (I think) for a patient to share on social media about a book their therapist has written or an journal article if those works have been influential to a patients healing process. Though things could get messy if it the author is identified as that blogger’s therapist. I’d personally never do so in a way that indicated that said individual was my therapist, but sharing a professional publication on a patients social media seems fare game if context were appropriate. I suppose for me the issue that comes into play is the inherent informality of twitter. No matter how professional a twitter page is, it is still something more conversational and more personal. And for this reason I feel a retweet would be overstepping a line.

Discuss. What are your thoughts?

 

Unrelated:

From my search stats it looks like someone is trying to get into my locked posts. I locked a few posts on here for assorted reasons related to protecting my privacy. If you want access to one of the locked posts, comment and depending on your motivations I might give you access.

Worry that is not psychosis

I have a bit of a paranoid streak to my personality. Not something that in itself can be diagnosed, but it impacts how some of my anxiety comes out.

Today I was walking home and a young man asked if I knew the area well. In a city a stranger initiating any contact can be a sign of a scam or other nefarious activity. But many a time I’ve rudely brushed off a lost tourist in error. He stood a little closer to me than was comfortable. We never broke walking pace. I didn’t stop and neither did he. I think he may have brushed briefly against my coat. I gave him directions. I slowed my pace to lose him via slow-walking.

Walking past the police station, should I go in to hide?

He went the wrong way based on my directions. Did he misunderstand or did he never really want directions? If he didn’t want directions what was his motive for talking to me? Is he looping around to follow-me? 

I wasn’t pick pocketed. He didn’t rob me. I’ve long lost site of him, but keep looking back to make sure I’m not being followed. 2 blocks away from my home I step into the entryway of a building and look back and forth. There are people, it’s dark but I think none are him. Did he plant a tracking device on me? Should I not go straight home? I get home and search everything. My bag has many pockets. No tracking device. I have some coins in the pocket on the side of my coat he’d been near. What if a tracking device looks like a coin? What if it is microscopic? What if he followed me and I didn’t see? I toy with the idea of throwing out the bag, just to be safe. What if he was trying some kind of RFID theft? I don’t have anything which could be stolen with RFID readers. 

——-

Another incident from over a year ago:

I was late for my bus. I ran towards it, only to realize I had run towards the wrong one and past my own bus. There are two that look similar. Embarrassed, I turned around and walked back towards the people I had just run past, the people who were boarding my actual correct bus.

This isn’t a public transportation bus. It’s a shuttle bus, because my work has multiple locations and buses people between them. The buses are primarily used by employees.  It’s a large organization so I don’t know everyone, but it’s not as anonymous as public transportation.

My heart was pounding. I had to take a seat in the very front, because I was the last on before the bus left. I usually sit more towards the back.

I put on my headphones to listen to my ipod so I could calm myself down. It’s a half hour to one hour bus ride depending upon traffic.

These buses are always eerily quiet. They don’t play music, no one talks. There’s not much engine noise.

My earbud headphones were loud, but not so loud that people could hear them. I had a gap between songs. Everything felt very quiet.

The contrast freaked me out. I wondered, “What if I was thinking too loudly? Could they hear me thinking?”

There are some reasons why this isn’t such an absurd thought. I have a tic-like problem with talking to myself (I have a post in more detail about this) The line between my brain and my mouth gets blurry and I don’t have 100% control. So the idea that my thoughts could come out in a way isn’t that strange. But usually I realize what’s up with the fist syllable out and can take some control. I don’t think it happened without my awareness that it happens at all.

But obviously no one is able to really hear my thoughts.

It started evolving.

No. No one is listening.

But what if?

Maybe it’s not the whole bus, maybe it’s just one person

No no no, no one is listening to your thoughts

I thought really hard to myself Hey you listening! Stop it!

Just in case.

There was a postsecret about this. I was glad to see someone else could identify with this.

The thoughts got more detailed

Yes the whole bus wasn’t listening. It was just this one person, a guy. He was sitting behind me. I couldn’t look back. But he was there listening. I didn’t even know if a guy was back there at all.

Well maybe. Probably not. But I persisted in my demands that he leave my brain. Just in case.

And then I got off the bus and continued my day like nothing had happened. No more thought listening fears.

But now whenever I get on that bus. I have to sit in the back, because sitting in the front freaks me out.

There’s a nagging worry that people might maybe be able to hear my thoughts. But only on this bus and only if they sit behind me. And I’m not sure, it’s just a precaution I’m taking. Just in case.

I felt like I was finally losing it. Going up to the next level of crazy. But no it didn’t count, right? Because I knew it wasn’t real. I was just worrying. Just in case.

—-

I think now that this is less of a psychotic symptom and more a sign of extreme anxiety.

I know my brain is out of control, I struggle to turn it off. But I know it is not real. There is no tracking device and no one is reading my thoughts. The ‘What if’ possibility taunts me. My worry gives too much weight to improbable situations.

 

Search terms answered #5

This is part of a series where I answer interesting questions that come up in my search terms, that are not already clearly answered in this blog.

I feel less able to write some of the personal topics here that I used to discuss. You may have noticed that in the past I commented about how small the field of psychology seems, but it seems the more I am immersed in it the more it shrinks. This blog still gets a lot of search engine traffic so I will try to help out in a small way with some interesting search terms.

“is it okay to go back to the same therapist”

Yes. You can go back to the same therapist. A professional should not see this as a problem. But do carefully consider the reasons you left before when you choose to return. Often when I returned to previous therapists similar problems which led me to leave the first time around caused me to leave the second time.

Of course many people have left their past therapists on good terms and might want to return for a “tune up”. This is not a problem and it’s very normal to choose to come back for a couple of appointments or to return for a longer period of time if things in life have become more difficult.

“i miss my appointment today”

This search term and variations of it are pretty common reasons for how people end up at my blog (Second to the ones looking for help self-harming or hiding SI. If you want to SI I’m sure you can find a way without my help).

Missed appointments happen. It’s not a good thing for you to do, but if it has already happened call the clinician as soon as possible to reschedule. This is something that happens all the time. Don’t drop out of treatment over fear of their reaction. Just call, apologize and reschedule. If the clinician gives a reaction that seems out of proportion, then this is probably a warning sign that you should seek treatment elsewhere.

Some clinicians may charge for missed appointments if you didn’t cancel in advance, so check with your provider for their policy. Remember, when you no-show you have taken away a billable hour from their day which may impact their ability to support themselves.

“do psychology majors require you to do alot of presrntations”

As an undergrad, I don’t think  psychology majors do more presentations than any other major. This all really depends a lot on the professor more than the subject mater. If you do decide to purse a PhD in psychology though part of that involves research which involves presenting findings of that research. But these are not every day events. However, if you have a public speaking phobia, treatment for this may be beneficial for many careers (Not just psychology) because in most jobs there will be some need to talk in front of groups from time to time.

“self mutilation included in dsm?”

They’re calling it Non-Suicidal Self Injury (NSSI), but yes it will be in the new DSM. There’s concern in the field that use of the term mutilation may be stigmatizing so it’s generally not used now in academic circles.

ritalin cancels out adderall

This sounds like it might be less about one drug canceling out the other and more that high doses of stimulants can cause paradoxical reactions which make people sleepy. So mixing the two together may not double the effect.

“is plucking armpit hair a sign of trich”

It could be, but remember it needs to also cause impairment and/or distress. If you have a symptoms that does not cause impairment and/or distress it’s probably more of a personality quirk.

“methamphetamine triggering trichotillomania”

It’s very possible that methamphetamine could exacerbate existing trichotillomania or create symptoms that resemble trichotillomania since stimulants can cause problems with compulsive behaviors.

However  in the DSM IV for Trichotillomania criterion D is: “The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition). “

Current Methamphetamine abuse would likely exclude a trichotillomania diagnosis if the behavior only occurred in association with the drug use. If the symptoms remained after withdrawal criterion D would no longer be applicable. Whether Methamphetamine could create trichotillomania after the drug use is open for debate. It’s difficult to tease apart if it is something that was underlying before the drug use or something created by the drug.

“how do you know if you are grade obsessed”

If you are googling this it is probably a hint that you might be.

“should i date a pysch major”

Psych majors come in many forms. Ranging from crazy people like me to people who had no idea what to study. If you think you want to date the person, do it. Their academic major isn’t very informative for determining whether you should date them.

“is it normal to go through many therapists”

It’s a good question. I’ve certainly gone though an above average amount, but I’d love to know what amount is typical. I think it’s very normal to go through more than one. It can be really hard to find a good fit. At a certain point (like the point I’m at) you should think about the ways you contribute to going through so many therapists (too picky, trust problems?)  but some therapists may just not be very good and there’s no reason to stay with someone who can not help.

Search terms answered #4: “dbt therapy contract legally binding?”

This is part of a series where I answer interesting questions that come up in my search terms, that are not already clearly answered in this blog.

“dbt therapy contract legally binding?”

DBT contracts can vary in content but a year long commitment agreement is a very common component.

Short answer is no. It’s really more of a social contract or a promise. Same applies for any of the “self-harm” or “no-suicide” contracts.
I’m not a lawyer so I can’t speak to all the details of why it would be legally unenforceable. My understanding though is that a breach of (a real) contract is a civil issue, so monetary compensation would be what was at stake if one party broke the contract. Imagine if any other medical professional tried to do something similar. Can you picture an Oncologist telling their patient that Chemo is a really taxing process and they want to be sure of a patient’s commitment before beginning so they need to sign a contract? No. And that Oncologist certainly would not bring a patient to court (seeking monetary damages) for changing treatment options if they decided some other route was a better idea.

Your treatment is your own to control. Provided you are not in some type of court ordered (or inpatient involuntary) treatment you always have the right to refuse to do anything at any time.

I hate these contracts. Whenever people have presented me with them it’s always been them telling me to sign it or not get treatment with them. I feel bullied by it. Especially in the case of something like a contract to stay in therapy, I don’t think it is fair to always assume that leaving the therapy is a symptom of the problem. Some therapies or practitioners are not a good fit for some people.

Here’s my question for you readers: Is there anyone out there who feels a contract in therapy really helped them in the long run? Did it help you stick things out, in an ultimately helpful treatment, at a time when you were having doubts? Or was it coercive and damaging to add guilt about breaking a “contract” into the already difficult decision to change treatment?

Do I need to rethink my feelings about DBT?

I don’t usually post links to other articles here. That’s generally not my style. And judging from the content of this one, it’s probably going to get posted many other places.
I just have to share some of my reactions somewhere.

Here is the article
You may need to make a free NYT account to be able to read it.
tldr version: Marsha Linehan reveals her personal history of self-injury

DBT was not helpful for me. With other therapy types that have not helped I never really felt anger towards the big names that created it. I don’t have strong feelings towards Aaron Beck as a person even though there are some complex emotions going on for me about CBT. Things have been different with Linehan though.

Her name has been all over my experience of the therapy. When I was in DBT I worked in her workbook, which I pursed a copy of. In hospitals when DBT was shoved down my throat I used xeroxes of the same workbook.

After I quit DBT my (non DBT) therapist pressured me to take home DVDs of Linehan’s to watch. If I refused to continue the DBT therapy, she thought maybe the DVDs would help. They just made me angrier. I have pages of typed notes picking apart every detail of those DVDs. Some of them were obnoxious and irrelevant such as my criticisms of the lighting quality. Mostly I just felt that Linehan just didn’t get it. Combined with later viewings of youtube clips of her and videos of her I saw in school, I’ve developed a view of her as cold, mean and out of touch. The cultish language of DBT did nothing either to endear her towards me either. That she could possibly have a personal history of these problems was not something that ever would have occurred to me.

A lot of my anger towards this therapy, that was repeatedly forced upon me, became directed at her. She created this overhyped therapy that no one will believe is ineffective for me.

This article really turns a lot of my feelings upsidedown. I guess she’s not quite as out of touch as I thought. Some of these comments she made that seemed cruel make me think more now that she’s using humor as a way to deal with some fo these things.

I am not going to become a hardcore DBT advocate, but it does make me feel its worth a little more examination. Not so much as a treatment for myself (I’ve long ago ruled out the possibility of it being effective for me and strongly believe anyone who treats any therapy as a panacea is delusional), but in terms of general professional knowledge it could be useful. I still have theoretical objections and think DBT is backwards (behaviors should not be the first issue address with in a therapy, IMHO), but this gives it a little more credibility.

This news is certainly going to take over my therapy session today.

I’m still processing my thoughts about this. I don’t usually like to post here without digesting thoughts more, but I wanted to share while it was still fresh news. Feel free to add your thoughts on the matter.

—

Edit:
I walked into therapy and said “Hey, did you read the NYT today?”
S.M. replied “I haven’t finished reading it yet, but I bet you want to talk about the Linehan article”
He’s got me figured out.

Thanks

Thanks everyone who commented with support on my last post.
Just typing things out sorted some stuff out in my mind and made everything feel a bit more organized and less overwhelming so I started feeling better after writing it and from reading comments.

I’ve had a number of instances now in the past few months where I made an impulsive post here that I later deleted. I really want this blog to be less about in the moment freaking out and instead more looking at things about myself with some emotional distance.
Since I’ve had some instances where those messy emotion things have bled over into this blog they clearly are lacking a good place to go. Isn’t compartmentalization great? I get really jumpy about more ‘this is what is going on right now’ posts, because I think they make me more identifiable.

Would people be interested if I started a vent-y whine-y emotional blog that is password protected? I think I will also use it to tell about some things I’ve had to omit from here because I didn’t feel there was a sufficient way to disguise them to protect my privacy. There are a number of posts here where I had to leave out layers of complexity, because of my privacy concerns.
This new blog won’t replace this one, it’ll just cover a different area.
If so comment and I’ll make one and email you the link/pw.

edit: So the new blog is made. I’ve been sending out emails with the url and password to people who have commented.

Thought River

I’m having a rough time.
I’m sorry I’m not able to be as articulate when I’m very upset.
Here is my stream of consciousness.

High school English teachers used to get angry with me for writing in this disjointed way.
In my freshman year of college a prof told me my notes read like poetry.
I hate transition sentences and formal paragraphs.
Figure the transitions out on your own.

I don’t deal well with uncertainty
So many thing are up in the air right now.
I don’t know where anything will land.
I made an urgent appointment on Monday to see #27
and then saw him again at my regularly scheduled Tuesday appointment.
I need more support that that, but I just can’t travel all the way there very easily
It’s very time consuming.
I have so many commits and have done so little for them.
I’m using being busy as an excuse for falling behind on everything.
Oh sorry I’m overwhelmed doing X so I couldn’t get to Y.
In reality I’ve just been crying in my apartment.
My most productivity I’ve done the past week is writing two emails and scanning something.
I’ve gone out and physically been present at places I needed to be, but am not there mentally.
I actually went out yesterday and did something social.
A major rarity for me.
An old friend, from before I was crazy.
And I’ve been crazy for a long time.
She is is town for a bit and I insisted upon seeing her.
She doesn’t know my crap.
And she is going through some of her own crap, so I was able to forget some of my crap while taking a supportive role.
I had a good time.
Then came home and remembered everything.
Took some Klonopin and knocked myself out to sleep.
I need more support than I have access to right now.
I wish I could have therapy every day.
There’s just no way for me to get there.
All these ideas running though my head.

Maybe I could go to the school counseling dept and just only share certain information.
To supplement my real therapy.
Nothing about suicidal ideation or cutting.
Not about the bottle of suicide vodka in my cupboard
And the Klonopin I’m hoarding
That I’m saving for a synergistic drug interaction
There’s suicide grapefruit juice too, but I got thirsty and drank it as regular grapefruit juice.

Just talk about the terrifying uncertainty of not knowing anything about how my life will look in 2 months.
That’s socially acceptable.
I’m allowed to be stressed about this.
My stress is just out of proportion.
But it’s too complicated to hide bits in therapy
I did that with #24.
I refused to tell her where I worked or when to school
It got a bit ridiculous.

I easily meet the major depressive episode criteria
But what does that mater?
It’s all arbitrary
When is it dysthmyia and when major depression?
The DSM makes it seem clear, but it’s complicated

I laugh in classes.
I seem like I have a plan.
I’m taking it in stride.
I just fake it for a few hours.

All the therapists I see every day.
Not as a patient but as a colleague and student.
I hear them talk about self-injury and borderlines
Representing those with serious psychopathology.
No idea I’m there among them.
Well maybe I’m not borderline.
It all depends who you ask.
I feel offended personally when by derogatory statements against borderlines
Even if I am not a part of this group, I am perceived as a part of it.
The statement is directed at me.
Even if it is is not about me.

I did everything right academically.
Except for being crazy.
What else could I have done?
But nothing I’ve done matters.
I’m still in limbo.

The states are higher for me.
It’s not about a job and a career.
It’s about when I will kill myself.
My desperation is high.
I want it to work.
in that sense I want to live.
But I can’t stand the uncertainty.
I convince myself it won’t work and I should skip the waiting.
It was the same in high school.
I got into my first choice school.
Everything worked out.
Stakes are raised here.
I need to get back to seeing S.M. for therapy.
It’s not just a job, any job.
It’s a job where I can be happy.

If I have the time i would go to a partial program in the day
That’s the level of support I need
Not a hospital
Hospitals babysit
I’m not going to kill myself right now
But I need to keep things together so it stays that way
I’m envious of the UK bloggers who have access to this greater range of support services.
I just have therapy.
He’s (27) out of the office until Friday.
I didn’t listen to the whole voicemail message informing me
I hung up when I realized I’d have to wait.
He’s not that warm an supportive though.
More expressive on the expressive supportive continuum.
I need supportive now.

Crisis lines are only so helpful.
Awkward stranger pretending to care
Some better than others.
Sometimes i can ignore the awkwardness.
I hate giving background information.
I just want to pick up where I left off.
There’s a nice local crisis line, that allows that.
But their hours are few.
I always seem to freak out when they are closed.
You can leave a voicemail, they say.
But I’m scared to.

The national hotline.
The one that google recommends when you search about suicide methods
They connect to a random line.
Which is nice because calling specific ones I end up on hold.
Sometimes connected to ones where I’m not the target population.
Sometimes I get one where they say “Emergency Services this is ___”
I hang up, terrified.
I don’t want emergency services.
I just want to talk.
Don’t they realize they’re scaring people off with their greeting?

At the end of a crisis line call.
They have some time limit.
And they say call again anytime.
But I just feel rejected.
As they’ve kicked me off in the nicest way.

I have to go pretend to have my act together for the rest of the day.
Lots of talking and smiling and such.
So I’ll end this stream of consciousness post.
I usually put these in a more private blog, but I don’t think anyone reads that one.
Those are usually typo filled.
I tried to spell properly.
Some extra effort.
Just for you folks.
I’ll talk to you later.
And hope you’ll excuse the interruption from my typical posting format.

Why I persist in going to therapy after so many failures

I made this as a reply to someone’s comment in the last post, but figured I would also post it as its own entry.

You can see I have a bit of a bias towards insight oriented therapies.

Why do I go through so many therapists?

It doesn’t take long of reading this blog for someone to notice that I’ve met with a lot of therapists.

I’ve made reference to reasons why I think this is the case, but never organized all those thoughts together.
This is certainly something where if I fully understood it that maybe it would no longer be a problem, but I’ll share with you my current understanding of it.

Looking at the whole picture, it’s obvious to me that I have an avoidant attachment style. That’s the common thread running through this.
I should be clear though that an avoidant attachment style is not the same thing as avoidant personality disorder. Some have tried to suggest I have this, but I really don’t think it describes me well. My problem is with intimacy in particular. There are a lot of things aside from intimacy, which I find anxiety provoking, but I tend to push through that anxiety and continue to do those things.
I find close relationships threatening. People who are too friendly feel to me like their friendliness is an assault. I feel like these people like me more than I like them and that they won’t give me the space I need. To clarify I am referring to primarily to platonic relationships here.

My concern about them not respecting my need for space it probably partially a projection about my relationship with my mother, but it’s also been further reinforced by others who couldn’t take a hint to back off. My mom has very little respect for interpersonal boundaries. I’m an introvert and she’s more extroverted. She’s the very needy kind of extrovert, the kind who can’t fathom that other people might feel drained by interactions while she feels energized by them. My dad would step in sometimes and tell her to give me some space. She’d agree to do that, but 5 minutes later she’d be back to the same thing. I’d have to physically hide places (like closets) to escape her destructive consuming affection. For her expressing love is not a two person interaction. It is about her and her insecurities. There is a general consensus among my family that she has some type of undiagnosed learning disability that impairs her ability to recognize that she is doing something interpersonally destructive.

Now a days I can just hang up the phone on her. I know that sounds awful. But calmly telling her to give me space does not work. And after I hang up I have to turn off the phone because she will call over and over. My email inbox gets flooded with one line messages.

A couple of years ago I was staying with my parents for a bit. My mom had bought a new computer, which I set up for her. She’s very computer illiterate. She spent a day pestering me with questions about it (very basic things like installing word). I helped at first, but finally told her to use the Apple support number, since we’d paid for it already. The Applecare person was less tolerant than I was and actually hung up on her. I wanted just a couple of uninterrupted hours to myself after playing tech support all day, so I locked myself in a room. I barricaded the door, because locks in that house are easy to pick. My plan didn’t work out as well as I’d hoped. Within about 5 minutes my mom was banging on the door demanding I open it. It’s important to note that there was no reason she needed to be in this room. If I hadn’t been in there she’d not have wanted to get in.
She quickly escalated to threats that she was going to kill me and alternated between death threats and threats of calling the police. I don’t really think she would kill me, but in the moment I wasn’t about to open the door for someone threatening to kill me, even if they were not serious. And if the police had come I think they’d have understood why I’d not opened the door. And what crime could I be charged with for locking myself in a room in the house I lived in?
I was having a panic attack and wanted to escape out a window, but I was in my pajamas and had no shoes. My dad was on a business trip and called demanding that I open the door. It turned out that he was simultaneously telling my mom that if she called the police he would divorce her. He was on no ones side. Eventually I was bullied by my dad into opening the door.
Thankfully the next day was the day I was scheduled to move into my apartment.

That got a bit sidetracked, but I think it illustrates a reason why I find close relationships threatening. My mom’s affection is very aggressive. I’ve never felt unloved and my parents do care about me, but the way my mom shows this is very overwhelming.

The problem with looking at my therapy problem as an attachment problem only, is that when I look back at each therapist I’ve left individually I can think of good reasons why I left each. Globally there’s a picture of attachment style that emerges, but individually it looks different.

There’s also the issue of how I’ve been treated in prior therapy, which puts me very on guard about protecting myself from bad therapy.
It wasn’t until therapist #4 that I actually started using therapy for myself. Before it was something that I was forced into by my parents. I started seeing her because my parents felt I didn’t have enough insight about my ADD. The therapy eventually evolved into a place where I talked more about anxiety and depression, but it took nearly 2 years of more superficial conversation to get to that. The therapy was helpful in some ways, but I hit a point where I reached the limit of how much she could help. She became very pushy about some things. I agreed to start seeing #5 for DBT in addition to seeing her, but that didn’t work out when he demanded I phone him before I self injure if I wanted to meet with him. The theme between the two of them was that I received ultimatums where I either had to do something they wanted or I could no longer meet with them. After I quit DBT, #4 gave me a list of things to pick from. I had to do one or she would no longer meet with me. I picked that I would have my primary care doctor look at my cuts regularly. I felt very bullied by this.
I did leave for a little bit and met with #6. #6 was so much worse that I came running back.
The final straw with #4 was when she told me she wanted me to do DBT all summer instead of the summer job I’d just been hired for. I went to the job instead and am very glad that I did, because it was a wonderful experience.
In a way my tendency to leave therapists easily, is a protection against this sort of bullying. If a therapist tries to threaten that I should do something or else leave, well then I’ll just leave. I’m sick of being pushed around. Threatening to withhold therapy is not a useful form of treatment.
An unintentional outcome of these experiences is that I’ve become a lot more assertive in my daily life. I will stand up for myself.

Then there was #7 who got me kicked out of my school and #8 who I met for medication who told the doctors at my first hospitalizations to lie to me about my diagnosis.
This whole experience made everything more difficult. Not only could therapy be something that might not help, but it also became something that could potentially destroy my career and life goals. While a therapist might believe their intentions are pure, ultimately I am the only one who can protect myself and I need to be on guard to make sure the helpers don’t hurt me.

I’ll skip #9 and #10 mostly because that therapy was for the purpose of getting a note to allow my re-admittance to school.

Then there’s #11. S.M. My favorite one. He’s the only one I left on good terms with. There’s some idealization going on in there. I’ve tried to hide it from him, but by now he knows. I don’t like anyone seeing if I care at all about them. I’m so used to feeling horrified by overwhelming expressions of affection, that I forget sometimes that in moderation people actually do appreciate being told they’re valued and needed. While I would feel threatened by being needed interpersonally (needed in a professional sense is fine) most people don’t feel like that.
I left because I transfered schools and the new one is far away. At the time I didn’t think finding a new therapist would be a big deal. I thought that all psychodynamic therapists were the same (I sure was wrong about that) and that all I needed was another psychodynamic therapist.
If I’d realized how much trouble I’d have finding someone else I would have put more effort into finding a school in that area. I do think though that there are ways in which I’ve grown, through this struggle that I might not have had I stayed with S.M. the past 3 years.
My idealization of S.M probably made sticking with a therapist harder. I thought for awhile that maybe these other therapists who didn’t work out were just the wrong kind of psychodynamic. I now realize that there is a huge amount of heterogeneity within any theoretical orientation. While I like the psychdynamic approach, it was probably things outside of the theory that made therapy with S.M. work.

Things are going okay right now with #27. I’ll wait and see what happens.

All of the factors mentioned here probably contribute to some of the difficulty I’ve had in finding a therapist. Explaining partially why I’ve seen 16 therapists in the past 3 years. There are probably others reasons I am not yet aware of. I know that because I’ve personally had so much trouble, that I am the common factor in this. It’s at least partially my own fault. There are certainly elements (systemic and therapist factors) outside of myself that also contribute as well.
Even though it seems that with each therapist I see they become a little more disposable, it is still devastating to me each time I leave one. That one or two hours a week is very important to me. This importance is part of why I need so badly to be sure I’m in a therapy that is getting it right. If therapy didn’t matter I’d just be content in something mediocre.

Blurry

Ever since I started talking to therapist #27 about how I’m looking for a job, he’d mention the same thing.

“You should look into the work Dr. X is doing.”

And I’d smile and say, “Sure I’ll look into that. Thanks for the tip.”
But I’d never write the name down. By the end of the session the name would be long forgotten. And besides I wouldn’t want to use the tip anyway.
I don’t want to get a job referral from my therapist. I haven’t reached that level of desperation yet. I’m so worried about privacy and boundaries, the last thing I want is a job I was refereed to by my therapist.

Imagine the interview, “How did you hear about this job?”
“Err.. Um.. Google?”

I applied to a number of jobs this weekend. One stood out. It matches my interests more than anything else I have applied to. It’s a bit of a stretch for me to get this one in particular, but I figured it was such a perfect match that I needed to try.

I mentioned this job application in therapy this week and described the job a little.

And #27 asked again, “Have you looked into the work Dr. X is doing yet?”

And then I realized Dr. X was the person I’d applied for that job with.

It’s not a huge deal. I probably won’t get the job. It’s a long shot. And even if I did I wouldn’t avoid it because of this. It’s too wonderful of an opprotunity.
I can’t keep things separate to the extent I want them to be. What’s the opposite of the mental health field? I should have decided to go into that.