[waves]

i have a problem with therapy. i don't know if it's my tdoc's style (behavioral "approach" but not CBT strictly) or what. i have several lamentations on the subject.

• big picture. i say i want to look at a big picture and he wants to take it a bit at a time. i think we've had 8 years to look at many bits and examples to refer to. he says they are different. i say they are examples of a pattern i saw long before. i need help with the pattern, not with getting out of an individual instance. sure, getting out in general can be a good thing to learn, but since i create the pattern. i also need to learn to create different (healthier), not keep repeating the same crap where i need emergency meds and emergency escape routes to escape my own prisons after i make them.
  .
• feelings vs. behaviors. i want to work on how i feel about things rather than how i deal with a situation. for instance, i can "deal" with my teasing coworkers... i figure ignoring them will scoot them along to something more interesting. it took us 3/4 session to get here. i still have NO idea what to do about the FEELINGS that are evoked when these ppl tease. the feelings are about ME not about them, and my behavior towards THEM does control MY feelings. i got teased a lot and never ever learned, internally, to deal with it. INTERNALLY.
  .
• lack of continuity between sessions... to my knowledge docs here don't keep files, not even medical. the pts do. that includes xrays, labs etc, everything. so if you think your doc will need your history you gotta lug it all with you. it has good and bad sides. bad is, the docs can lose sight of critical info very easily. this GP rx'd a macrolide antibio first thing when i got here. i was on carbamazapine AND had informed him. had my pdoc in the US not warned me explicitly, i would have taken his stupid antibio and landed in ER or worse - the morg. Welcome to the Olde Worlde. this is how things are done.

those are the big ones. i've tried to resolve the last one myself but other than a few times i seem to go blank. i used to write things on paper till i became afraid of the papers being lost/found. things never got covered anyway... it wasn't working.

~~~~~~~~~~~~~~~

i've had my T/pdoc (same person) for about 8 years now. i like to think he knows me. he is certainly a good guy. he saw me free for 4 of those years because i was broke. i had some issue with this as a boundary violation (i felt and still feel an obligation to continue with him). i did not tell him that because otherwise at the time i was without T or pdoc.

i am not displeased (nor impressed) in terms of his pharmacological management. he is flexible and listens to me so if i prefer one med to another or prefer to try a lower dose etc. also he prefers to lean on the side of caution in terms of adding meds, he's not huge on cocktails though he'll use them, once shown that a single med fails. again on same page as me.

one thing that never fails to freak me out is when i ask for a med report (list) for bureaucratic purposes he asks me to dictate... or he'll say remind me what you're taking again... ????

however pdoc helps me if i need tests scripted through my GP (state) and GP is giving me a hard time. if he thinks the tests are reasonable of course. faced with a request from a specialist, the GP cannot refuse. whereas if i am the requester, not only can GP refuse, but he can get all huffy and puffy about it.

the way i see my pdoc now is via private therapy, with the meds folded in. he practices as pdoc-only in 2 clinics near where i lived before having to crawl back to the folks - too far to juggle with work.

SO if i got a new T, i think i'd have to get a new psychiatrist too and lose him completely. unless i didn't tell him and saw both - which i CANNOTTTT afford.

i get attached to people (things, too!) so i can't imagine changing ... and possibly ending up with ... well, not better, for sure. then again i don't feel like the therapy is particularly therapeutic....

~~~~~~~~~~~~
thank you for reading. sorry for the usual longwindedness... when i write these i always think with admiration of Bizi's short 'n' sweet posts.

~ waves ~ confused

[bizi]

Dearest waves, I love reading the in depth stories that you tell. You give us important information and some in-between knowledge as well.
My posts are generally short if I am not running hypo manic or am not caught up in a narcisitic stage because I really am not well versed in information....It is easy to post a hug or a kiss to let some one know that I am thinking of them.
having said all of this....
how do you feel about this?
Do you want to get another therapist or can you "change " your current tdoc/pdoc?
bizi

[Dmom3005]

Waves

I have to say, I would hate it if you didn't post all these nice long threads.
s.


I learn so much when you do.

I too wait on your thought

[Mari]

Originally Posted by waves

get attached to people (things, too!) so i can't imagine changing ... and possibly ending up with ... well, not better, for sure. then again i don't feel like the therapy is particularly therapeutic....

Dear Waves,
One option is to find a DBT group that would be an alternative to the current doc. You could find some workbooks and audios.

Can you take a 4 month break from him to try someone else? You agree with him that the forth month is temporary?

SO if i got a new T, i think i'd have to get a new psychiatrist too and lose him completely.

Find out if this is true. Can you keep the pharmacological management guy and find someone else (not permanent) for talk therapy about feelings.

Originally Posted by waves

get attached to people (things, too!) so i can't imagine changing ... and possibly ending up with ... well, not better, for sure. then again i don't feel like the therapy is particularly therapeutic....

I remember reading years ago that finding a good therapist can be harder than finding a good friend. Considering finding a new therapist requires instense dissatisfaction at the status quo., willingness to deal with change, and trust in onself that one can make the right decisions.
You can change when you are ready. Take your time.

M.

[Dmom3005]

Waves

I believe that Mari has some very good ideas.

I would like you to see about these options.

I really do believe it about finding a good therapist before a good friend
at times.

But honestly what would I know I don't have either right now.

Sometimes I wish I had both.


I have a hard time making friends. Its from my childhood, and I can totally
understand that. Its so different here, making friends.

They don't just go find a new one and leave old ones to the side.

Donna

[bizi]

i agree donna, it is hard making friends. the last new friend I made was when I took an art class and we were sitting next to each other and we started talking....we sometimes get together and always enjoy her company, we used to chat on face book but then she stopped coming on line at night when I was on line.
Putting yourself in a new situation is a great way to meet new people...it is hard putting yourself out there.
bizi

[waves]

Originally Posted by bizi

Dearest waves, I love reading the in depth stories that you tell.

Thanks Bizi.

how do you feel about this?
Do you want to get another therapist or can you "change " your current tdoc/pdoc?
bizi

i don't think i can "change" anything more than minimal aspects, but when i have tried to address the 3 "big" areas i brought up in my first post i have not succeeded - and it's been a long time trying.

i've often put to myself, if it hadn't been for the money thing, would i have left already? of course conscience and sense of debt prevents me from even entertaining that notion for too long.

Originally Posted by Dmom3005

Waves

I have to say, I would hate it if you didn't post all these nice long threads.
s.


I learn so much when you do.

I too wait on your thought

LOL thank you, Donna! You're such a sweetie.

Originally Posted by Mari

Dear Waves,
One option is to find a DBT group that would be an alternative to the current doc. You could find some workbooks and audios.

i'm looking but not finding. aside from finding groups that are not near me, most are inpatient or require a Borderline Personality dx. I would like someone i could just have as a therapist, who could teach me to improve, say, stress tolerance, for starters - one of the basic elements used in DBT. THAT ONE THING would help me a lot.

i wonder if i can find someone specializing in DBT who ALSO takes other patients... so i could benefit from some of the DBT aspects without doing the full-blown thing. There just doesn't seem to be much DBT here. It kinda surprises me. It's not that new at this point. Maybe i'm not looking in the right places. Or maybe it is still very much in the private sector and i don't have visibility ... you have to know someone who knows someone...

Can you take a 4 month break from him to try someone else? You agree with him that the forth month is temporary?

i've taken a break before. but it was like 5 weeks. a sudden 4 month break - and TELL him i am therapist-shopping??? i don't think i could do that, no. it would be mega-WEIRD. i could try something like saying i only want to do 1ce a month, and then see a different one once a month... until i figure out what's what... then maybe by the time i'm 90 i'll find someone???

Find out if this is true. Can you keep the pharmacological management guy and find someone else (not permanent) for talk therapy about feelings.

problem is the only person i can ask is my pdoc. this reveals that i am wishing to leave/unhappy with therapy. perhaps that would be a good thing to reveal. but not the part about looking around...

Considering finding a new therapist requires: [Mari's list with answers inline:]
- instense dissatisfaction at the status quo - check.
- willingness to deal with change - check
- and trust in onself that one can make the right decisions - NO

i guess i fail a prereq's huh. and then there's the letting go bit which is a personal prereq that i fail with flying colors. but assuming i passed all prereqs with flying colors, i don't know how to go about looking.

You can change when you are ready. Take your time.

I may never be ready, just like i never would have been ready to start working again. furthermore i found previous writings similar to this post .... one dates back to 2005 - i am certainly taking my time... i daresay too much of it.

Originally Posted by Dmom3005

They don't just go find a new one and leave old ones to the side.

Donna

sometimes they take a trip across the ocean they don't want to take, thinking they're coming back. and then the world turns around and says, sorry, not today, not tomorrow. and then the friends drift away... move from phone to e-contact to nothing at all. and i think in our age bracket it is hard to make new friends. i am so grateful i have you guys.

thank you all so much for your replies. So much food for thought. i am thinking how i can do part of this or a little of that... i am thinking. thank you. and any more innovative ideas welcome.



~ waves ~

[Mari]

Originally Posted by waves

Thanks Bizi.
i Maybe i'm not looking in the right places. Or maybe it is still very much in the private sector and i don't have visibility ... you have to know someone who knows someone...

problem is the only person i can ask is my pdoc. this reveals that i am wishing to leave/unhappy with therapy. perhaps that would be a good thing to reveal. but not the part about looking around...

Waves,

You are right in thinking that DBT likely exists near you.
You have not yet found how to ask the right questions of the right people.

I don't think that my tdoc was formally trained in DBT. But she does a lot with mindfulness. If someone asked her if she does DBT, would probably say "no." If you asked her to do the following that you list, she could do most of i.

Originally Posted by waves

~~ . . . i need help with the pattern, not with getting out of an individual instance. sure, getting out in general can be a good thing to learn, but since i create the pattern. i also need to learn to create different (healthier), not keep repeating the same crap where i need emergency meds and emergency escape routes to escape my own prisons after i make them.

~~ . . . i want to work on how i feel about things rather than how i deal with a situation. for instance, i can "deal" with my teasing coworkers... i figure ignoring them will scoot them along to something more interesting. it took us 3/4 session to get here. i still have NO idea what to do about the FEELINGS that are evoked when these ppl tease. the feelings are about ME not about them, and my behavior towards THEM does control MY feelings. i got teased a lot and never ever learned, internally, to deal with it. INTERNALLY.

ONe thought I have is that your doc is not exactly doing CBT. Maybe you can look for a CBT person.
Here is a link for CBT:
http://www.rcpsych.ac.uk/mentalhealt...ments/cbt.aspx

When does CBT help?

CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.
How does it work?

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:

A Situation - a problem, event or difficult situation

From this can follow:

Thoughts
Emotions
Physical feelings
Actions

Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.

Most of what you describe in your last two posts are exactly what Cognitive Behavioral Therapy does.

M

[waves]

Dear Mari,

yes i will have to be more specific perhaps in the way i pose questions to ppl i interview. if i manage to do this it will be shots in the dark beyond what i can et through the phone.

i just realized a typo in one of those parts that you highlighted, thought i better correct it - i'm missing a 'not' - inserted in red.

"i still have NO idea what to do about the FEELINGS that are evoked when these ppl tease. the feelings are about ME not about them, and my behavior towards THEM does NOT control MY feelings."

in the uncorrected form it may have misled to think that i believe my behavior towards others then feeds back into how i feel. that is not what i meant to say. i meant to say, while on the one hand i can perhaps handle the social (external) aspects in a useful way, that is not true of the feelings (internal).

CBT is basically behaviorist theory applied to humans, channelling through the thought process. it holds that feelings are the result of thoughts. i think this can be true in some cases (and CBT is useful applied to those) but not all.

i think sometimes feelings are produced in other ways, emerge spontaneously. sometimes the problem is not the quality of feeling, but the intensity. managing feelings in real time is something i need to learn. i believe this skill is distinct from analysis of feelings, and necessary regardless of their "cause" if any.

thank you for helping me to think these things through.

~ waves ~

[mymorgy]

i believe in being thin skinned
love
bobby