dylarama
May 10, 2015 10:04 PM Subscribe
How do I request therapy that's more medically/concretely focused without being perceived as drug-seeking or noncompliant? Complication: previous use of diverted psychiatric drugs.
I have ongoing problems with anxiety and past problems with depression (though the latter has receded in the last few years and I'm primarily concerned about the first.)
I sought therapy a few years ago for both, and found it frustrating and disappointing. It was through a student counseling center (staffed by the counseling training program there), and it was pretty basic talk therapy. I don't find it cathartic to talk about unpleasant experiences. It mostly just functions as a reliving of the bad experience, which would be fine if there were some greater insight at the end, but there wasn't in this case. Most of the sessions were just me sobbing as the counselor looked on with a patiently blank look on her face as I tried to calm down enough to explain why something had upset me (the real answer, of course, was that it usually didn't make sense and I didn't know why and that was even more upsetting.) After about 3 months, I realized that all it was doing was making me ruminate on upsetting things and then feel worse for not being able to talk about or resolve them in any way, more or less ruining a whole day a week, without any real benefit on the other 6, and I quit. Looking back, I should've said "You know, this really isn't helping, is there something else we can do?", but I felt like it wasn't something I could or should say, and that I was the problem anyway and why couldn't I be better at this (Anxiety! It is grand. At ruining things.)
What's really helped in the last few years is getting a better handle on being able to identify when my thoughts are spiraling out in an illogical way and figuring out ways to redirect that nervous energy or ways to break the loop. Kind of a self-directed DBT. I cope a lot better than I used to, but there are still things that I'd really like outside help and guidance on dealing with, but that earlier experience has left me leery of therapy.
And oh yeah, the last thing. A friend with an emergency script for Klonopin who hated it gave it to me (yes, I know this is not an advisable thing to do.) I stretched ten or so pills over the better part of a year, just for especially bad days. And it was amazing how much better I felt--not high or anything, but just able to not have that constant interruption/distraction. (It also was pretty much how I realized that I was self-medicating with/abusing alcohol, because it felt like that moment I was always shooting for with drinking, where everything calmed down just a bit and I could focus, but without the whole being drunk thing which was not a great thing to be doing as often as I was.)
Anyway. I would like help with strategies for handling my anxiety better. If I'm being totally honest, I would also like a small supply of prescription anxiolytics for occasional (every few weeks or months) use for when non-drug coping methods aren't working well enough. I would not particularly like to be in "talk about your day" therapy, but I will give it a sincere try if whatever professional I go to for this thinks I ought to. Where do I go (psychiatrist? GP? someone else?) and what do I say when I get there, because I'm pretty sure saying "i want help but i don't want to talk about my feelings and also could i have some benzos please" is going to go over pretty badly with most psychiatric professionals. Alternatively/additionally, what can I do to get more out of regular talk-therapy?
I have ongoing problems with anxiety and past problems with depression (though the latter has receded in the last few years and I'm primarily concerned about the first.)
I sought therapy a few years ago for both, and found it frustrating and disappointing. It was through a student counseling center (staffed by the counseling training program there), and it was pretty basic talk therapy. I don't find it cathartic to talk about unpleasant experiences. It mostly just functions as a reliving of the bad experience, which would be fine if there were some greater insight at the end, but there wasn't in this case. Most of the sessions were just me sobbing as the counselor looked on with a patiently blank look on her face as I tried to calm down enough to explain why something had upset me (the real answer, of course, was that it usually didn't make sense and I didn't know why and that was even more upsetting.) After about 3 months, I realized that all it was doing was making me ruminate on upsetting things and then feel worse for not being able to talk about or resolve them in any way, more or less ruining a whole day a week, without any real benefit on the other 6, and I quit. Looking back, I should've said "You know, this really isn't helping, is there something else we can do?", but I felt like it wasn't something I could or should say, and that I was the problem anyway and why couldn't I be better at this (Anxiety! It is grand. At ruining things.)
What's really helped in the last few years is getting a better handle on being able to identify when my thoughts are spiraling out in an illogical way and figuring out ways to redirect that nervous energy or ways to break the loop. Kind of a self-directed DBT. I cope a lot better than I used to, but there are still things that I'd really like outside help and guidance on dealing with, but that earlier experience has left me leery of therapy.
And oh yeah, the last thing. A friend with an emergency script for Klonopin who hated it gave it to me (yes, I know this is not an advisable thing to do.) I stretched ten or so pills over the better part of a year, just for especially bad days. And it was amazing how much better I felt--not high or anything, but just able to not have that constant interruption/distraction. (It also was pretty much how I realized that I was self-medicating with/abusing alcohol, because it felt like that moment I was always shooting for with drinking, where everything calmed down just a bit and I could focus, but without the whole being drunk thing which was not a great thing to be doing as often as I was.)
Anyway. I would like help with strategies for handling my anxiety better. If I'm being totally honest, I would also like a small supply of prescription anxiolytics for occasional (every few weeks or months) use for when non-drug coping methods aren't working well enough. I would not particularly like to be in "talk about your day" therapy, but I will give it a sincere try if whatever professional I go to for this thinks I ought to. Where do I go (psychiatrist? GP? someone else?) and what do I say when I get there, because I'm pretty sure saying "i want help but i don't want to talk about my feelings and also could i have some benzos please" is going to go over pretty badly with most psychiatric professionals. Alternatively/additionally, what can I do to get more out of regular talk-therapy?
Well, you need to go to someone who can write you prescriptions if you want medication, so either your primary care doctor or a psychiatrist. If you don't have a psychiatrist, start with primary care and they can make a referral if necessary, but in many cases primary care doctors feel comfortable at least starting treatment for uncomplicated cases of anxiety or depression without making a referral.
Regarding the question of getting medications, that part shouldn't be as difficult as you're expecting it to be. Don't go and say "could I have some benzos, please" - even though that probably would work. Just go and tell the doctor that you want help with your anxiety, that on a daily basis it's not really a problem but that occasionally, maybe once a month it gets really troublesome and interferes with your ability to lead a normal life and do your regular activities. You don't need to get into "I took some of someone else's Klonopin and it was great!" But if you wanted to you could say "I've tried Klonopin in the past, and it helped me." (on preview, what un petit cadeau said!) It's definitely not a red flag just to tell a doc that Klonopin helped you. It's a very effective anti-anxiety drug. They will likely recommend continued therapy in addition to medication. If you find DBT techniques useful, finding a therapist who specializes in this might be a good idea.
posted by treehorn+bunny at 10:24 PM on May 10, 2015 [1 favorite]
Regarding the question of getting medications, that part shouldn't be as difficult as you're expecting it to be. Don't go and say "could I have some benzos, please" - even though that probably would work. Just go and tell the doctor that you want help with your anxiety, that on a daily basis it's not really a problem but that occasionally, maybe once a month it gets really troublesome and interferes with your ability to lead a normal life and do your regular activities. You don't need to get into "I took some of someone else's Klonopin and it was great!" But if you wanted to you could say "I've tried Klonopin in the past, and it helped me." (on preview, what un petit cadeau said!) It's definitely not a red flag just to tell a doc that Klonopin helped you. It's a very effective anti-anxiety drug. They will likely recommend continued therapy in addition to medication. If you find DBT techniques useful, finding a therapist who specializes in this might be a good idea.
posted by treehorn+bunny at 10:24 PM on May 10, 2015 [1 favorite]
My primary care doc gave me a prescription for lorazepam really without any trouble. I had tried them before because I had really bad vertigo, so I knew I could tolerate it. I described my fear of MRIs to my doctor before I was about to go into one and he wrote me the prescription, and now when I see him he just does a prescription check and writes me refills. I use one once in a while as needed. You should probably just ask your doctor.
posted by clone boulevard at 10:38 PM on May 10, 2015
posted by clone boulevard at 10:38 PM on May 10, 2015
IME, most GPs and psychiatrists will almost always want you to try SSRIs first. I was once prescribed Ativan (by a psychiatrist) for clearly situational panic attacks (which I experienced for the first time in my life) in response to an unusually stressful situation. During the same period, my GP wanted me to go with SSRIs, even though I reminded her of some very aversive side effects I'd experienced with one in the past. The psychiatrist is the one who heard me out on that, fwiw. Maybe that's just a random difference, or maybe it's because psychiatrists are the psych drug specialists and more comfortable making a judgement in favour of a benzodiazepine, I don't know.
That said: although I used it sparingly, only in emergencies, and I don't think I'd get hooked, I know what you mean when you say it's just really good. It completely cuts out any kind of nervous buzzing - it's you, but better (if a little slower); it's you, minus the buzzing you've been living with for a long time. For that reason, I think it's a little too good, especially if you have an ongoing problem with anxiety.
I've found that valerian root tea or pills (standardized, German) helps me chill out in a similar way, albeit to a slightly lesser degree. I'm ok with the possibility it's just a placebo.
posted by cotton dress sock at 12:23 AM on May 11, 2015
That said: although I used it sparingly, only in emergencies, and I don't think I'd get hooked, I know what you mean when you say it's just really good. It completely cuts out any kind of nervous buzzing - it's you, but better (if a little slower); it's you, minus the buzzing you've been living with for a long time. For that reason, I think it's a little too good, especially if you have an ongoing problem with anxiety.
I've found that valerian root tea or pills (standardized, German) helps me chill out in a similar way, albeit to a slightly lesser degree. I'm ok with the possibility it's just a placebo.
posted by cotton dress sock at 12:23 AM on May 11, 2015
So, about a year and a half ago, I had a very similar problem. Spikes in anxiety, full knowledge of what didn't work (very similar-sounding therapy experiences to what you're describing, but also including a couple of decades of trying various psych med regimens), and basically just wanting to handle things myself except with benzodiazepines as a back-up plan. And, thanks to some bad doc experiences in the past, a total terror of seeming like a big crazy drug addict asking for more drugs.
I was basically just honest with my new GP. I told her a little about my history, that I had made an effort at both meds and therapy. I tried to keep that part of the conversation emotionally neutral (well, as much as I could--there were points where I was trembling so violently and my teeth were chattering so hard that I simply couldn't make words come out...but hey, my body picked the perfect time to prove how bad my anxiety was!). The reason I say it that way, "emotionally neutral," is that I felt it was wise to leave out my more negative feelings about my psychiatric experience. I didn't want to put anyone on the defensive by talking about how much my therapists sucked, well-meaning though they might be, and similarly, did not want to go into my sermon about psych meds.
I kept it to the basic facts of my history, and the fact that benzodiazepines helped cut through the panic enough to let me get a handle on things. Brief history of the problem, current status of the problem, proposed solution.
The conversation went much better than I feared. The GP did give me quite an extensive drug test, but thought my plan for very occasional benzo use made sense as long as it worked, and so now, on checkups, we talk a little about how I'm coping, and I get my refill, and that's that.
The only thing is...well, I'm not even sure how to say this. Drinking makes things complicated, both from a talking-to-your-doctor point of view, and a taking-benzos point of view. It's tough to tell for sure, from your question, whether you're still self-medicating with alcohol or not. It sounds very much past-tense in your description, but do expect it to come up in the conversation with your doc. Just be aware that if it is ongoing, it needs to factor in to whatever treatment plan you work out with your doc, because you really don't want to be mixing the two, and it may raise red flags about addiction potential to your doc.
posted by mittens at 8:02 AM on May 11, 2015
I was basically just honest with my new GP. I told her a little about my history, that I had made an effort at both meds and therapy. I tried to keep that part of the conversation emotionally neutral (well, as much as I could--there were points where I was trembling so violently and my teeth were chattering so hard that I simply couldn't make words come out...but hey, my body picked the perfect time to prove how bad my anxiety was!). The reason I say it that way, "emotionally neutral," is that I felt it was wise to leave out my more negative feelings about my psychiatric experience. I didn't want to put anyone on the defensive by talking about how much my therapists sucked, well-meaning though they might be, and similarly, did not want to go into my sermon about psych meds.
I kept it to the basic facts of my history, and the fact that benzodiazepines helped cut through the panic enough to let me get a handle on things. Brief history of the problem, current status of the problem, proposed solution.
The conversation went much better than I feared. The GP did give me quite an extensive drug test, but thought my plan for very occasional benzo use made sense as long as it worked, and so now, on checkups, we talk a little about how I'm coping, and I get my refill, and that's that.
The only thing is...well, I'm not even sure how to say this. Drinking makes things complicated, both from a talking-to-your-doctor point of view, and a taking-benzos point of view. It's tough to tell for sure, from your question, whether you're still self-medicating with alcohol or not. It sounds very much past-tense in your description, but do expect it to come up in the conversation with your doc. Just be aware that if it is ongoing, it needs to factor in to whatever treatment plan you work out with your doc, because you really don't want to be mixing the two, and it may raise red flags about addiction potential to your doc.
posted by mittens at 8:02 AM on May 11, 2015
FWIW, I don't think you'd be viewed as drug-seeking just because you went to talk to a psychiatrist about what sounds like a pretty pronounced anxiety disorder. You should definitely tell someone with an MD that you're having uncontrollable thoughts that are causing you anxiety. That's what benzos are for. He/she might want you to start with SSRIs to get your baseline anxiety under control, and might recommend therapy at the same time (try finding someone who does CBT rather than talk therapy), but there's nothing about what you're describing that sounds at all drug-seeking.
posted by Mayor West at 7:53 AM on May 13, 2015
posted by Mayor West at 7:53 AM on May 13, 2015
This thread is closed to new comments.
When you go see your new psychiatrist, you don't have to mention where you got the benzos from; just say that you trialled them in the past and found them helpful. Using some kind of benzo PRN is actually a pretty good option for acute flare-ups of depression or anxiety -- those bad days that you're talking about -- and you can take them 2-3 days a week, pretty much indefinitely, without developing a tolerance. It's certainly much better for you than drinking. So that's not a bad option, but it would be more efficacious overall to try out a SSRI (or some other kind of anti-d) first, so you don't have to get to the point where you have to swallow the benzo in the first place.
posted by un petit cadeau at 10:21 PM on May 10, 2015