"It is the Relationship That Heals"

If this is your psychiatrist or therapist run...

I am always struck by how much support I get in my comments and how many thoughtful people comment. This was going to be a response to the comments in my last post, but it has turned into its own post instead...

I love to hear from people who comment on a regular basis. I feel like over the years I have developed relationships/friendships with many of these people. I also feel really good when I hear from those who rarely or never write. It feels like the beginning of a mutual support system. I am glad my writing reaches out to people. I hope it continues to do so. Your comments often inspire posts...like this one, so comment away.

I write this blog, not just for myself, but also for others trying to work through and battle the same or similar issues and demons. People sometimes comment about how open I am. My original intent for my blog was to try really hard to make this as close to therapy as possible. I wanted to push myself to be open and as completely honest as I thought I needed to be for therapy to work for me.

I also planned to use it to prepare for my therapy sessions, to debrief after my sessions, and to push myself to become brave enough to talk about deeply personal, and often scary thoughts I have. In writing I hoped I am able to show others that therapy is a rewarding, and helpful process, even if it is sometimes really, really hard to fully participate in.

I was hoping that if others could be "insiders" in another person's therapy sessions, if they could see my process, my difficulties, my struggles, my successes, my cycling, my wingbat thoughts and ideas, my creativity, my attempts to get better, and even my failures: I was hoping others might take a chance with their therapist; try hard to open up in therapy, to go to therapy if they never have, to address there darkest secrets, to address any patient/therapist disconnects in therapy, and to find the therapist or psychiatrist that truly fits their needs.

Before I met Dr. X. I had already been to therapy numerous other times each with varying degrees of success, and sadly often failure. With most of the therapists I saw there was either a complete disconnect between myself and them, or if it worked I was in need of a longer course of therapy, and I believe medication which no therapist ever mentioned was available.

I now believe I needed to somehow muster up enough energy to be more of an advocate for myself...Though I know, when severely depressed that may not be possible. If I were to have a second chance to be start at 19 again, if I needed to see a new psychiatrist/therapist, I would approach it as a customer trying to find the best "product"/"service"/treatment for me.

I would be more assertive, have greater expectations, ask more questions and not settle for the first person who comes along. I would have looked for someone like Dr. X from the start. Of course, that is easier said than done.

Below are some of the things I would look for in a psychiatrist/therapist if I had to look again:

When meeting a new psychiatrist or therapist, make a list of the types of behaviours that are important to you in someone you are seeking help from.

Be open to new ideas and approaches.

Ask them questions.

Listen to how they answer your questions. Are they welcoming? Do they sound put off by your questions? Are they caring?, or pushy?, or short?

Do they have time for you?

Are they just medication oriented?

or Do they provide therapy? (I find it really helpful to have a psychiatrist who does both).

Do they LISTEN?

What are there credentials?

What kind of experience do they have treating people like you?

What type of therapy do they practice? I find the less dogmatic about a particular therapy style the better....Use whatever works!

How flexible are they?

Do you feel comfortable around them?

The last sentence...Do you feel comfortable around them? ...is tricky, because many many times, probably during each of my sessions, there is some degree of feeling uncomfortable around Dr. X. Even 8 years into therapy I feel guilty, or ashamed, or afraid, or even angry at him periodically. The test of being comfortable lays in whether I can talk about my uncomfortableness...even if it takes a few sessions.

If I feel he has said or done something I am uncomfortable with, and I can safely work through and see this as an opportunity to discover something about myself and others...then it is indeed a powerful and psychically "comfortable" relationship.

The question I try to ask myself when this happens is whether these feelings are coming from me and my mood or experiences, or whether the psychiatrist or therapist is doing or saying something, that promotes my feeling ashamed, afraid, intimidated etc

I "understand" (in my rational mind) Dr X. is NEVER judgemental, or angry, or pushy, or authoritative, or any other way that might increase or promote my feeling bad in therapy. That does not mean I do not ever feel these things. Who I am, what I have experienced etc. impact my reactions towards all my relationships' experiences and interactions

Some Psychiatrists/Therapists (like some people of every persuasion or occupation) are pushy, or arrogant, or sure whatever they say is right, and the patient knows nothing about helping themselves. They tell the patient to just do whatever they tell them to do etc. This is the kind of therapy/doctor, that I always found did not work for me. For me a good therapist and/or psychiatrist forms a partnership with their patient, values their patients ideas and lets the patient know they are valued

Some of my readers have expressed difficulties, or difficult relationships with, with their psychiatrists and/or therapists. I believe it is important to delving into into why I might feel that way. What kinds of behaviours, exchanges, actions, thoughts are taking place both in and out of therapy that are leading to your feeling a disconnect?

In his book, "Love's Executioner" and in his novels and psychotherapy textbooks, Psychiatrist Irvin Yalom writes and expands upon the idea that, "it is the relationship [between patient & psychiatrist or therapist] that heals". My experiences in therapy with Dr. X have reinforced and proven this to be the case for me.

I try to remember therapy is sometimes difficult. During some phases it can see impossible a lot of the time. As people with depression, or other mental illnesses, (really as people even with no mental illness)... as people period, we may have difficulties with some relationships in the first place; maybe that is even why we are in therapy.

If I find something happening in my sessions that disturbs or perturbs me I always ask myself is the difficulty in therapy the therapist, or have I not opened up and taken the chances I need to take in therapy.

• Is it my issue clouding the session,
• Are my symptoms such that they are affecting my judgement (not always easy to know)
• or is the therapist doing something hurtful that negatively impacts my ability to open up?
• Is my therapist a good therapist?
• Did they just make a mistake,
• or is their attitude always this way?
• Is it my approach to therapy?
• or is it the therapists approach that is making it not work?

The most important thing I can do as a patient is talk to my psychiatrist or therapist if I am feeling uncomfortable, or hurt, or diminished or disconnected in any way. I may not have the courage to bring it up while it is happening, or even during the next session, but if something about my therapy is festering inside me...I always bring it up.

Everytime I have brought difficulties up he is completely open to discussing what went on. He apologizes if a mistake was made on his part, or we discuss my reaction if we discover my perception might be coloured by other things. He accepts and encourages my feedback no matter what. This is part of what makes our relationship so important and the bond so strong.

I guess what I am trying to say here is that the first therapist you see, even the fifth and sixth therapist you see, may not be right for you . Don't give up because your therapy does not seem to be working for you.

Therapy, and good relationships in therapy, is/are hard work. If the relationship between you and your psychiatrist or therapist does not seem to have a positive impact on you maybe try approaching your therapy a different way, or try a different kind of therapy, tell your therapist how you feel. If it still is not working perhaps trying a different therapist or psychiatrist would be the positive change you need.