My ongoing therapy dilemma

[gooblax]

I'm barely managing to avoid creating a spreadsheet of all the various PD traits with columns to check off whether I think I meet the criteria in one situation or across multiple situations etc. I don't really know if it'll be a useful exercise or just a gigantic waste of time (but surely no more of a waste of time than doing it non-systematically has been). I'm leaning towards gigantic waste of time, especially if I have impaired insight. However if my therapist were to tell me whether he's considering any in particular, it would be less of a waste of time because then we could discuss whether I do or don't agree with his assessment on a trait-by-trait level.

I have my appointment with him tomorrow after work but am delaying responding to the automatic reminder sms due to my usual conflict about the sessions.

 

[gooblax]

Therapist is sick today and had to cancel.

 

[Daniel E.]

Sorry to hear that. Maybe he will credit you then if you ever have to cancel.

BTW, one of my pet peeves about therapy:

At least in the US, it is the norm to be charged for appointments cancelled with less than 24 hours notice -- which is another reason why I usually pay by check rather than a credit card I have never cancelled with less than 24 hours notice, but I always thought the policy was stupid since there is no penalty for the therapist having to cancel at the last minute. It is understandable since they deal with a lot of no shows, but shows a lack of parity at the start of the therapeutic relationship.

 

[gooblax]

Maybe. At least I could put it forth as a point if the situation arose.

Yeah it's the same general policy here. I understand it from the perspective of not being able to fill slots at short notice, it makes sense to avoid having people able to cancel at a whim with no recourse... but on the client's side if they genuinely wanted to make the appointment but just couldn't it does come across as a bit of a dick move.

 

[Daniel E.]

and very outdated since a private-practice therapist who charges for a missed appointment can provide some assistance by asynchronous messaging like e-mail that does not require scheduling.

 

[gooblax]

Haha yeah there's plenty of things I can think of for them to spend the time doing for the client's benefit. I assume some therapists would do some of them off their own back (like maybe research into a problem the client was having etc) but I'm not going to be optimistic about the proportion.

I seriously hate whatever this transference/attachment/whatever-term-you-want-to-use stuff is though. Maybe now that I've spent 1.5hrs being sad and crying on-and-off I can move on with my afternoon. :facepalm:At least he didn't have to cancel during one of my "he doesn't care" thought blocks or it would've been extra messy for me to deal with.

 

[gooblax]

Maybe I should stop seeing my therapist (yes I know, but it's a different reason this time) because that way I'll stop having over the top responses like yesterday. If I don't see him then after awhile it won't matter anymore.

 

[Daniel E.]

Incidentally, I have noticed that some therapists are offering remote therapy for the first time due to COVID-19. I found one that charges only $65 for video therapy. For the few therapists who take my insurance, my copay is$ 40. So $65 is cheap.

Right now, I am on a break again from therapy myself since my OCD is in remission again -- relatively speaking. And I did not like my last therapist. (I had a bad feeling about him since he seemed to be blaming me for my anxiety, and then I looked up his record. Then I felt quite validated as to why he was trying my anxiety like an addiction -- because of his own addiction to alcohol that led to a DUI, which was detailed with his MSW license info.)

When I am doing better, the OCD takes a back seat to positive obsessions or "positive addictions." Like now, I am trying to find good camping sites. I usually go through cycles where there is OCD as usual, then OCD more than usual, then depression from the OCD/anxiety being too much, then I "cool my jets" and eventually the OCD is relatively gone. Then back again...

 

[gooblax]

My therapist has temporarily reduced his fee for the moment while everyone's on video. It's annoying that I can't get any rebate (govt or insurance) with him due to location but if he's going to diagnose me with something that gets stigmatised and misunderstood then I'd rather that not be on record anyway.

I've realised that I have to keep seeing him at least until he tells me what the hell is wrong with me. I just need the quickest way to tell him the information he needs to make a decision and to show that I understand enough about things such that telling me wouldn't be 'harmful'.

 

[Daniel E.]

I've realised that I have to keep seeing him at least until he tells me what the hell is wrong with me.

Not exactly a solution-focused approach?

In other words, what you are saying reminds me of the medical model where there is the diagnosis and then the treatment. But having a diagnosis in mental health is not necessary for treatment and, in theory, can even get in the way (as in self-fulfilling prophecies.)

But I understand what you are saying in that you would like a diagnosis -- something to go on. But there is more right with you than wrong with you, as someone used to say. Whch brings me back to the solution-focused perspective, which I have always liked since it avoids blaming the person -- more so than some other therapies that have resistance almost baked in (as in traditional CBT where there can be a higher rate of resistance, dropout, or non-compliance even to one's own self-defined goals and desired behaviors).

 

[gooblax]

I get your point but it does seem like it would be a solution to almost constantly wondering and researching and making my own self-diagnosis spreadsheet.

 

[Daniel E.]

As one of my previous psychiatrists used to tell me, the medications treat symptoms -- not a diagnosis per se. So even if the meds or another treatment works well, you can still argue about what is the best diagnosis or if any even applies (other than having the human condition or "adjustment issues.")

Even in the case of OCD, OCD may not be one's biggest problem/hurdle compared to adjustment issues of some sort or generic problems with human psychology. I was diagnosed with OCD very early on, but it did not exactly help me knowing that -- or did not seem to at the time since I just had more questions about what else may be "wrong" with me.

 

[David Baxter PhD]

Depending on his credentials and licensing, also be aware that he may not have the legal authority to provide you with a diagnosis. That is a restricted function in most geolocations.

Perhaps you should try to clarify that with him. Maybe that's part of the reason he has been reluctant to answer your questions about diagnosis?

Echoing what @Daniel said above, I am concerned that you are giving the issue of diagnosis too much weight, to the point of obsessing about it.

You have said previously that you don't want to reveal what it is you fear about a diagnosis and I respect that, but make sure that you can answer that coherently for yourself. At this point, you have a fairly good idea of who you are. How would any diagnosis or a specific diagnosis change that self-view?

 

[Daniel E.]

Another potential issue is that for too long, psychotherapy has been too focused on the individual as the "problem" as opposed the one's environment, culture, etc.

If I had a dollar for everytime a therapist hasn't asked about my current work or home environment, I would have at least 50 dollars I have noticed psychiatrists sometimes have more sense in this department or line of questioning regarding "problems of living."

 

[gooblax]

I think the only reason I'm obsessing about it now is that he said he couldn't tell me yet. It's like a real-life cliffhanger ending to an episode of a TV show... where this plotline only airs for 1 hour ever 3 weeks, and I'm the character coming up to one of the show climaxes but I have to keep going into sidestories for the other 503 hours. My therapist got hold of part of the script somehow and knows a bit about what's coming up but won't share it with me. So while I'm waiting for the next episode that actually involves the plotline that I'm interested in, I'm coming up with theories like a mad fan of the show. Except it's worse, because I also am a character within the show I know I can influence the way in which the episodes play out. If I play badly, I delay getting to this plotline's climax (possibly with episode upon episode of useless sidestories) or mess things up entirely and get to an early "choose your own adventure" wrong ending in the story. Whereas if I play well, I find out sooner what the climax is and can then move on with the rest of the plot.

 

[gooblax]

Do you think there's any chance of therapy actually helping (with what?!!!) or am I just going to remain obsessing about it and stuck?

 

[David Baxter PhD]

Can therapy help? Yes.

Can this therapist help? I don't know.

 

[gooblax]

It seems pretty hopeless at the moment.
I don't know if I'm still miserable from the cancelled session, or just from how that affected my work for the rest of the day (and tbh the next day too), then due to the bad days of work I didn't have a particularly good weekend... Or if I would've been obsessing about the diagnosis stuff and feeling crappy regardless.

 

[Daniel E.]

I think if you could see a therapist more often that may help, such as seeing a therapist who charges less (even a US therapist) or one that does e-mail therapy. As I have mentioned before, your frequency of therapy (which seems to be every 3 weeks now?) is usually considered to be more like maintenance therapy (which would be fine if it was working for you -- but it doesn't seem to be working for you).

In the old, old days, going to a therapist was more like piano lessons for a concert pianist -- even going every weekday.

Going to therapy every week is expensive. Which is why a lot of people cannot afford to do it unless they have more money than usual, or have insurance, or find cheaper therapists. On the positive side, it usually pays for itself in the long term, and "graduating" to going every 2 weeks can seem how going every week used to.

 

[gooblax]

I have been thinking a bit about the session frequency and briefly mentioned it during the post-session-blowout phonecall a few weeks ago but it didn't really get discussed. I don't think my therapist will suggest changing the frequency unless I bring it up (based on his stance of 'not pushing').

I'd have to look at my budget (or, re-make my entirely outdated budget) to see what I can do about session frequency with him or if I'd have to find something cheaper. I hate budget stuff.

I'm also not sure to what extent I'd be starting from scratch with difficulty opening up etc. It's still a bit of a problem but it's getting better with this therapist. I was thinking I could test that by having a couple of EAP sessions so it's like a free trial run... But since I wouldn't be sticking with whoever I get for the EAP counsellor (max 6 sessions I believe) it's not really a fair test.

But then I wonder if maybe I should just reduce or end sessions entirely so maybe it would decrease the apparent importance of therapy in my mind and so I could move on with other stuff instead.... Except I wasn't doing superbly without it either so I dunno.