Sunday, August 28, 2005

May You Get What You Want

I am such a flip flopper...Now I am feeling all stressed out again about my appointments being cut back.

I started to feel like maybe he is punishing me for something...I even asked him a few weeks back to be a "punishing therapist"...isn't this where that old adage "be careful what you wish for" comes in??? There is an old gypsy curse, "May you get what you want" that reflects this thought too. (I love that curse...except of course when it pertains to ME!!!)

What would I be being punished for???...
  • The med screw ups I have had in the last few weeks. I got into the valium again...and I have trouble with benzos and withdrawal...but I was/am soooo depressed and soooo stressed out. I just did it to relax a little. Anyways...I'm off them now...and when I took them he said we could try it with the gabapentin and modafinil to see if it was a good I did not think he was mad at me.
  • Maybe he read my blog and thinks I need to stop thinking about him and therapy so much.
  • Maybe I wear on him. God knows I can't seem to get better for some stupid reason.
  • Maybe I'm doing something wrong...not sure what, but I always feel like I am doing something wrong and about to get caught. I always feel like it is my fault that my depression won't go away, or get better. Feel like I am not trying hard enough...even when others say I am trying too hard...I feel so useless and tired all the time. I cannot seem to get going on anything.
  • Maybe I am making the medications not work? Not sure how...maybe I do not believe enough that they will (My husband constantly screams at me that they won't), or maybe I am too picky about the side effects. I feel like I try really hard to let them work...but I simply cannot function on most of the meds I have tried...either I get so tired I cannot do anything, or I get so anxious I get even crazier...or nothing happens and I remain severely depressed.

Anyways...I guess we (he and I) are going to have to have the "I feel rejected/abandoned conversation AGAIN...because obviously, while I thought I got it, I don't

Friday, August 26, 2005

Freed Up

Okay, I take back all the negative things I said last time. I was not being abandoned. I was being "freed-up".

I am so proud of myself today. I was brave in my session today and brought up how I left the session in shock...wondering how, when I was brave enough to ask for a change to accommodate my needs, I left feeling like I had been dumped like a hot potato. His response: "I did meet your request to change appointment times very enthusiastically with a response that meant cutting our sessions from twice to once weekly". I was confused and asked him why he was so enthusiastic...explaining I was feeling like I had burdened him too much by remaining depressed for so long and that that was why.

My Pdoc explained he felt that it might be a good idea to shake things up a bit. He thought it was a valid trial, just like a new medication trial, to see how the amount of therapy impacted my mood. He also mentioned that he tends towards being a passive therapist...meaning he tends to sit and listen to the patient vs. taking the lead and making decisions for them. He said he would not change that, and likes that about himself, but he wanted to try a little less passive approach to see how it went.

I have to agree with him on both counts. While I am still really stressed about going from seeing him twice a week to only once a week, I think his decision for us to try therapy one day a week is a sound move. Also, the reason he is a great therapist (and the absolute best I have ever encountered) is that he is an incredible listener (what he labeled as "passive"). He has this innate ability to listen and to allow the patient to make their own decisions. That is not to say he does not step in and help when we need it, or push when we need it, but he understands indecisiveness and amotivation are symptoms of depression and cannot be overcome by making the patient's decision for them. There is nothing worse than a therapist who tells you WHAT to do and WHEN to do it. I need to make my own mistakes, thank you very much.

I asked him if he was honest with me and told me the truth all the time? I wanted to be sure that I could trust him when he tells me I am not overwhelming him with not getting better. I worry I burden him. He said, absolutely he was honest with me, and he believes he would always tell the truth, even if the news is bad, (although, he said he would find a constructive way to bring that up). He said the only time he might not tell me the whole reason behind something is if the reason was a personal reason, or troubles he was having...he said that would be irresponsible of him to use my time, or to impact me because of that.

At the end of the session my pdoc asked me how I felt the session went. I told him I felt really good about being able to bring this up, and that I was glad he was open to the feedback. In fact, the second I saw him in the waiting room, I knew he would be and I knew I could safely discuss all I was feeling. I tend to get overwhelmed by change and I think my thinking was coloured by that. I also think one of the biggest reasons I was feeling so scared was because I feel so safe in his office. I translate that safety into a belief that I need MORE safety (i.e. more appointments).

In fact, when I am extremely depressed sometimes I fantasize about laying on the floor in my Pdoc's office...just being in a safe place, where I can just be, and not worry incessantly like I do in the outside world. My Pdoc made it clear today that we can always review the number of appointments we have together and we can always talk about these sorts of fact he said they are some of the most important conversations to have. I am going to try really hard to make this change a positive one.

Wednesday, August 24, 2005

Blind Sided

I don't know what happened in my session yesterday, but I left feeling pretty much blind-sided and abandoned.

Last Friday I left my appointment feeling like my psychiatrist was extremely supportive, caring and very empathetic. I felt he really understood how much I was fearing being abandoned and ending up alone. I felt really cared for even though I was so upset and sobbing much of my session.

On Thursday last week I received a call from an Art Therapy Program I go to saying my name had come to the top of the list for the next acrylic painting class...Did I want to take it? I had refused once before as the time conflicted with one of my appointments and when that happens you go down to the bottom of the list again. So this time I thought two things:
  • I really want to take this class...and creating art does seem to help me
  • I was feeling brave enough to actually ask my pdoc to accommodate my need for a different appointment time so I could take this class and still see him twice a week. I have such a hard time asking for any sort of accommodation from anyone I even perceive to be the slightest authority this would be hard for me to do.

So after carefully practicing how I was going to ask for this, I went to my appointment, sat down, told him about the Art Class, and asked if I could change my Tuesday appointment time. Immediately he says, "How about I see you once a week on Fridays. If you find you need to see me more we can arrange that then. I am really flexible with my hours and you can call me and arrange another appointment if you need it".

I am sure to those of you reading that statement you are thinking...sounds totally reasonable and supportive....but you don't know my history around this whole twice a week appointment scenario. I will not call him...and he knows I will not call him. I would not call him if I am about to commit I am not likely to call to say, "Help, I need an extra appointment". I have cut my appointments down to once weekly before and I always lose it and get even more depressed.

The thing is...I do not understand why now? Why is he cutting me off when I have been so depressed recently. I feel like I can barely hang on right now. Why is he abandoning me like this right now? He said he wants me to expand my horizons, that he knows I have limited energy because of fatigue and motivation and wants me to spend my energy on things that make me feel good. He worries that the time I spend in therapy drains me of my energy. What the FUCK???

I feel (usually feel) supported and cared for in therapy. On days I have an appointment...Tuesdays and Fridays...I actually leave my house and get into the city and do things before and/or after my session. My sessions helped me do, and feel safer doing, other things. In fact, less than three months ago I was concerned that I was too dependent on him...his response..."Wasn't it important to have someone to come to, someone you know supports you, someone to lean on when you are out in the world trying to do the things that scare you"?

I feel like something weird happened. I do not think he is being honest with me. I think he saw an out and took it as quickly as he could. I feel totally let down...and angry that when I am so severely depressed, (but finally had the courage to ask for him to change his schedule to meet a need of mine), I got shot down in flames.


Sunday, August 21, 2005

Another Failure

Another failed medication trial...and the list of failed treatments and meds grows to 25 plus meds, ECT, years and years of therapy...argh! My husband has been raging mad at me. Thinks all I need to do is "stop worrying so much", or, "just stop thinking about your depression"..."The medications make you worse", "You have never been as depressed as you have been these past 5 years since you started to take the medications".

I am so depressed I do not have the fight in me to argue these points anymore. When he starts his anti-med, ant-psychiatry rant I feel intense rage inside, like I am going to explode into a million pieces. I feel intensely criticized and in turn guilty for not being able to get better. Does he really believe I would remain so depressed if all I needed to do was "stop thinking about it"?

He fails to comprehend the extent to which depression takes over my mind. For weeks now I have been plagued by extreme suicidal ideation. Feeling unable to keep trying I set up extravagantly detailed plans on how I could go in the least painful way possible, but ensure total success. Then I begin to rage at how unfair it is that I feel so sad and my plans become more violent in nature...aimed at punishing and killing myself in the most violent ways possible.

I am stuck here though because I cannot do this to my family. Having the thoughts over and over and over, but being unable to act on them is like being stuck in hell. I want so bad to go, but know I never will be able too. I wish there was a switch to shut off my thoughts when the ideation starts.

I feel ashamed at having all these s. thoughts...and while I discuss them with my pdoc I leave out details because I feel like I am being so childish and weak. I feel I should be able to stop these thoughts, to overcome my depression, to get back to work, to get out and choose to live.

I do not understand how I went from an intelligent, vivacious, life loving person, with a promising someone who is unable to work, lucky I can get out of bed and out of my p.j.'s many days, and so tired, fatigued, anxious, irritable, depressed all the time that I am unable to do much of anything anymore.

While arguing about my depression getting worse my husband started to talk to me about separating the other day. He sounded very serious. While I have brought the subject up before, because I am certain his constant criticisms of me and my psychiatric treatments have got to have a negative impact on my ability to get well, this was the first time he ever brought the subject up.

I felt distraught and spent all night thinking about how I was going to have to live in my van. Visualizing being cut of disability insurance, having no money, having nowhere to live...I could see myself ending up on the street. Everyone tells me these thoughts are irrational. I do not feel that way though.

I feel like the possibility of a descent into homelessness is simply a matter of degrees. All it would take is a loss of income, or such a small disability income that one could not afford to live and a loss of a sense of interpersonal support (just like how when I am depressed I isolate myself, but also feel isolated from everyone too). When I severely depressed and isolated I do not reach out or ask for help. When I am severely depressed I cannot see viable solutions to these kinds of predicaments.

Anyways...I'm here, not living in my van yet (at least I have a van to live in..ha, ha) and I'm going off the last of 3 meds in my latest combo...I suppose preparing to try something new. Please let the next medication work!!!

Wednesday, August 03, 2005

Daydreams and Horoscopes

I was just sitting around reading the newspaper. Well actually half reading and half daydreaming, thinking about how to move my life forward. Thinking about how my psychiatrist is telling me he thinks I would be motivated to do more if I had some external motivation. He was not talking about a punishing type of motivator, not something that represents the militaristic style of your father, but a more caring version. So I have been thinking of ways to set up my life so I have some external motivation.

One of the things I long for is to be able to return to school. I love to learn, I loved university. Honestly, my last two years of university were the best two years of my adult life. My classes were so interesting. I felt challenged and exhilarated by the lectures, the essays, the discussions (exams sucked...but hey!).

I want to take a class. However, I get so freaked out about going to school, or committing to anything because my mood is so unpredictable. Some days I feel able to do anything I want to do. Most days I feel I will fail at anything I try. Concentration and memory problems plague me , so I worry I will not be able to manage the reading, or recall enough to pass the exams. I often get mired in a perfectionistic nightmare...obsessing over and over about what I have done wrong with the work I hand in.

I remember giving my psychiatrist a copy of an essay I had written for a class I took a few years back. The second I walked out the door I felt sick for having given it to him. I immediately "knew" he would think I was stupid and incompetent. I obsessed for two weeks about how awful the essay was, and how I had destroyed his perception of me. In the end I received an A+ on the essay, but I still thought it was a crappy essay and that I received the mark for some reason other than my competence.

Anyways...(got a bit off track there)...While daydreamingly reading the newspaper this a.m. I started thinking I might like to try auditing a creative writing class. I reluctantly flipped to the horoscope page.

Reluctant because, have you seen how brutal the Gemini horoscope has been for the last few weeks? Everytime I open the paper to read my horoscope in the past couple weeks it has expressed that my vehicles will have mechanical problems, it threatens that I will have trouble with insurance companies and financial organizations. ...God give me a break...I am already afraid to answer the phone or go to the mailbox, afraid I will get some awful news about my disability insurance being cut off, or that I need to see one of their psychiatrists, or whatever...

Man, off track again...Anyways, the point I wanted to make in this whole long winded post was that I daydreamed about taking this creative writing class the whole time I was reading the paper, wondering if I could do it, if it was a good idea etc. I flipped to the horoscope section and the last line of today's horoscope read..."Creative writing is a great choice" Perhaps that is a predictor of a fortuitous change in my life...hmmm?

Tuesday, August 02, 2005

Punish Me (please)

Today I barely made it to my session on time. Used to be I would leave my house an hour early and arrive with at least 15, or 20 minutes, to spare. Gave me time to grab a coffee, get my thoughts in order, and calm down from the drive into the city...(insert all sorts of expletives here focused at all the bad drivers that seem to fill up the city I live in).

Anyways, lately I am leaving the house later and later, arriving at my pdoc's with minutes to spare, if that. I do not think this is a coincidence, but I am not %100 sure why I am unconsciously trying to make myself late:

  • Trying to shed my "good girl" image with my pdoc?
  • Rebelling about "having" to go to my appts (obviously it's my choice...but I can see how in many ways the choice is only as free as my feeling that I will survive without the support)
  • Feel like what's the point of going to my appts...It's been 4 years and I'm still depressed
  • Feel like I have nothing left to "entertain" my pdoc with...God it must be so boring to have to listen to me say the same things over and over and over...
  • Maybe I am ready to leave...and just practicing...NOT!
  • (Most likely)...I want to end the therapy before I am abandoned...either emotionally...(boredom, disgust, negative judgment etc.), or physically...(pdoc moves, or something happens to him, or he decides he does not want to see me anymore because I am not trying hard enough)

This fits with my sessions opening comments...I need a therapist who is more punishing, so I feel forced to do things. "What does a punishing therapist look like", pdoc asked me. (all sorts of explicitly sexual images came into my mind immediately...I will tell you why another day)...but I digress...

A punishing therapist lets me know there are consequences for not doing things. "What kinds of consequences?", the unpunitive pdoc asked. I explained, "if I did not do what I was supposed to do, then my appointments would be cancelled, or you would stop seeing me. I get things done when I am afraid of being punished, maybe that would help me here". I was being a bit facetious, but in many ways I feel like I would try harder if I was being "managed". I am simply not accustomed to being so accepted no matter what I do, how I act, what I say, how I feel.

My pdoc says there are many types of parenting styles...The tyrant style...where the parents tyrannical behaviour places their children in a state of constant fear, and guardedness. Effective in the short term because the kids are afraid to do wrong. However, the children will likely rebel and become wild when they leave home. Then there is the opposite style, those parents who set no boundaries, and their kids run wild and get into all sorts of trouble. Then there is a more balanced style where the parents set boundaries, but also allow there kids to grow and explore.

My father was the tyrant...I was terrified of displeasing him...and when I left home I became wilder than wild. As I get older I have become my own tyrant...I use guilt and self recrimination to egg myself on, to try to force myself to do things. What I end up doing is feeling more guilty and more self hatred when I fail to move forward. So I guess I am thankful that every Tuesday and Friday I have a pdoc who attempts to "refather" me from a moderate parenting perspective.