How to stop self-defeating and help them to help me?
January 17, 2012 10:49 AM   Subscribe

How can I approach the task of analysing my own mental health professionals without defeating myself before I even get started?

For six years now I have been a patient with a mental health service specializing in treating personality disorders. My case manager has asked me to write to him to tell him what aspects of my time with the service have been helpful, what aspects have been harmful, and what aspects haven't made a difference either way for me. He told me that the reasoning behind this request is to guide them in deciding how best to offer help that will be helpful. When I queried if this was a preliminary step in the service attempting to kick me out, he told me that this was not their intention, but that I should consider whether leaving the service would be useful or not.

One of the reasons I am being asked to do this is because I frequently find it difficult to say anything, either to flag up when I am struggling, to ask for help, or to explain what is wrong. It is often easier to put things in writing than it is to say them aloud. Another is that since May last year I have been going through a prolonged and intense period of depression and anxiety which has involved being hospitalized three times, and led both the service and my husband to question whether anything they're doing for me and with me is helping or hindering. I have had depression since early childhood (was first diagnosed with depression at 15 and am now 30) and have had bad times before, but they have never before been this bad, nor lasted anywhere near this long. Although I have now returned to work again after having been on sick leave for months, there doesn't seem to be any sign of improvement - I returned to work because I'd run out the clock on available paid sick leave, and staying at home didn't seem to be helping at all. Working isn't helping either, but at least this way I'm being useful to someone and getting paid.

At first I tried to approach the task as if I were writing an essay. I wrote a framework of section headings that I thought I needed to cover of some of the various things that have happened over the years, and I put them in a vaguely coherent order. I thought that if I then wrote a few sentences to go with each of the headings about whether specific things the service had done had helped or not, and if not whether the issue might lie with external obstacles or my own fault or with their approach, and if them doing anything different might have helped change that specific outcome for the better, then the end result would be a reasonable stab at answering the question. I thought that maybe breaking the question down into smaller specific chunks might make it easier to handle.

That was last week. And I haven't written a single word since. Every time I think about the task I get overwhelmed by the scale of it. I feel guilty and ungrateful for questioning the efforts of the professionals who have put a great deal of time and effort into trying to help me, even though they have explicitly asked me to question them. I blame myself for being depressed at all, and doubly so because I feel helpless to do anything about it and hopeless about any prospect of meaningful recovery. I keep focusing on the pronouncements of several of the psychiatrists who assessed me whilst I was in the hospital, who told me that since my depression and anxiety are caused by my personality disorder, I will feel this desperate and this despairing for the rest of my life and there is nothing anyone can do to help me because I am not genuinely ill. I feel guilty for the valuable time and scarce resources that have been wasted on me when they should have been given to others who stand a chance of recovering. And at the same time, I keep worrying that this whole exercise is a way for the service to justify abandoning me. That if I say anything bad about them, they will get angry with me. That since I am unfixable and worthless, they are right to cut their losses and abandon me. That I should do the decent thing for all concerned and remove myself from the equation before my existence does any more damage to everyone around me.

What should I do? How do I approach the task I've been given in such a way that I can answer the questions asked of me, instead of getting sidetracked and overwhelmed by the side issues and imagined catastrophic consequences of doing so? Am I already on the right track and just need to push harder, or is there another way I should be coming at this which will let me get through my own ruminating self-defeating monologue for long enough to tackle the actual question and get a meaningful answer?
posted by talitha_kumi to Health & Fitness (10 answers total)
 
Can you make three lists? One for helpful services, one for harmful, an one for neither helpful nor harmful? I think the most important thing is to be honest. If you aren't sure about something put it in multiple columns. As long as you are honest, there is no right or wrong answer. Did he ask for explanations as to why things were helpful/harmful? If not, then you don't need to flush out explanations for the items on the list. If something is unclear and he needs further explanations, that's OK, he can ask you follow-up questions. Simpler may be more helpful. It doesn't have to be perfect.
posted by TheCavorter at 11:05 AM on January 17, 2012


As a public relations professional once said "You have to answer a question. You don't have to answer the question they asked, you just have to answer one."

In this particular case I would focus solely on the "what helped" portion of the question. Get that written, give it back to them, and tell them you'll work on the other parts.
posted by Tell Me No Lies at 11:06 AM on January 17, 2012


If you're stumped on what specific points to address, an idea might be to look up articles and books (online or at a library) that provide guidelines for choosing mental health professionals. You could run down the recommended criteria of what to look for in a good therapist, for example, and note how well your own therapist meets each quality.

Please don't remove yourself from the equation, of course... I'm sure, if you find it too uncomfortable to dwell on this stuff or you get trapped in a mire of depressive thoughts that's difficult to get out of when you try to write, they don't need anything like an academic paper. Quite possibly you could simply bring the framework you've already written to someone and just verbally discuss the things on that list.

Don't blame yourself; the nature of mental illness is such that it will cause exactly these sorts of difficulties.
posted by XMLicious at 11:40 AM on January 17, 2012


>every time I think about the task I get overwhelmed by the scale of it.
>>I feel guilty and ungrateful
>>I blame myself ...because I feel helpless... hopeless
>>>I keep focusing ... who told me... I will feel this desperate and this despairing for the rest of my life... there is nothing anyone can do to help me because I am not genuinely ill.
>>>>I feel guilty
>>>>I keep worrying that this whole exercise is a way for the service to justify abandoning me.
>>>>>That if I say anything bad about them, they will get angry with me.
>>>>>>That since I am unfixable and worthless, they are right to cut their losses and abandon me.
>>>>>>>That I should do the decent thing for all concerned and remove myself


You are going through the thought-process that is probably the basis of your depression; note that this process is probably content-free. It is a formula, like a kind of mental lens, that you can apply to any content, and produce the same negative emotional state.

If they haven't shown you how to recognize this mental process, interrupt it with a strong emotional input, and then substitute it with something that gets you to focus on the here and now-- like the pleasant feelings you can dare yourself to not notice in your hand--, then they have done you a disservice.

Perhaps you can point out, within your critique, their failure to train and condition you to interrupt your own habitual thoughts.
posted by darth_tedious at 11:45 AM on January 17, 2012 [2 favorites]


Your second-to-last paragraph is a very clear and complete statement of why this task is difficult for you. I would consider sharing it with the person who asked you to write up your feedback, and request that that person respond to each of the concerns you identify.
posted by prefpara at 11:52 AM on January 17, 2012


"Criticizing" is not being ungrateful--it's what you were asked to do. Not to do so would be "ungrateful" if anything. What's more--the expression of what didn't work and what you need is therapeutic, so do it. They're not expecting perfection, so don't worry about getting things wrong.
posted by Obscure Reference at 1:09 PM on January 17, 2012


Thank-you, all of you. For the reassurance and the suggestions alike. You've all been very helpful, and I wish I could mark all of you as best answer.
posted by talitha_kumi at 4:20 PM on January 17, 2012


Instead of doing this task, I recommend getting different assistance for your intractable depression. I recommend seeing a psychiatrist for a consultation, diagnosis and med review and a PhD therapist on an ongoing basis. 6 years? They need to be helping you find effective help.
posted by theora55 at 5:54 PM on January 17, 2012


First of all, you don't have to do this homework if you don't want to. If they insist, then you're better off leaving this treatment center.

Your overwhelmed feelings about this obviously mirror what you're feeling about yourself and your problems in general -- do you understand that? If you were to express that to your case manager, would s/he understand, do you think?

If you want to attempt this, please don't think of it as writing a thesis. Here's the assignment again"

"what aspects of my time with the service have been helpful, what aspects have been harmful, and what aspects haven't made a difference either way for me. "

Write 2 things that have been helpful, 2 things that have been harmful, and 2 things that haven't made a difference. 6 sentences. Free associate. Don't overthink. Hand it to your case manager, saying, "this is what I"ve come up with so far." The end.

People who are seriously depressed and anxious, as you say you are, don't generally have loads of ideas flowing freely into prose! If your case manager doesn't get it, well, then I agree with theora55 above who says, go someplace else. You want want to do that anyway. But PLEASE try to understand that your guilt about being ill, all of that, these are SYMPTOMS of your disorder. You are in no position to evaluate your own symptoms right now.

So...see if you can knock out those six sentences (if not, how about 1 thing in each category?)

It would be wonderful if you could report back to us.
posted by DMelanogaster at 5:01 PM on January 19, 2012


I emailed my case manager this morning with my response to the "homework". The format of making three lists and adding one or two sentences per item on the list worked in the end, once I tossed out everything I'd done previously and started from scratch. I also added a link to this thread at the bottom of the email, as a means of explaining some of the difficulties I had, and showing him the suggestions people made here that were helpful. Thank you to everyone.
posted by talitha_kumi at 3:26 AM on January 23, 2012


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