Need help sorting out my mental health treatment
January 7, 2017 12:05 PM   Subscribe

Very confused right now.

Thanks in advance for reading this-- since joining the mefi community I've made a lot of progress in my life thanks to the poignant and informed comments of you mefites out there. I honestly don't know where I would be without you.

I started therapy last March or so. . I had been dealing with anxiety and depression off and on since I was a teenager, with one particularly bad episode when I graduated from my undergrad. It was only last year that I had the time and stability to start therapy for real. (I'm 28 now).

For the first 6 months of the year I was just doing talk therapy with my therapist, but then in July and August I had a huge increase in stress due to my old toxic workplace, and I was super fortunate at the time that a family doctor in my city had an opening right at the time when i needed it. He's an amazing doctor who happens to have a background in mental health and it's the first time I felt my issues were understood. He prescribed me an antidepressant which I had tried in the past (cipralex) but I found it didn't help much. So I switched to and SNRI, Venlafaxine (aka Effexor). I've found it very helpful (and I was deeply skeptical).

Then, I lost my job in August (it was a blessing not even in disguise) and had about 3 months during which I focused on recovering from a traumatic work experience ( not sure if i'm allowed to use the word 'trauma', but that is exactly how it felt). I enrolled in a 7-week CBT group for social anxiety and I have found it enormously effective (but sadly it's over now).

When I enrolled in the group session, I took a break from my individual therapist because I thought it would be too stressful to do both at once. Also, because I have doubts about my therapist herself. My issues with her were ( and I have no idea if these are real problems or just obstacles in my mind):
-- She barely spoke in the sessions, I felt I had to constantly come up with things to say. there was no structure.
-- I feel that she was projecting her own issues onto me. I had been talking for months about the death of my father when I was 7, when out of the blue she blurted that her husband had died when her children were young. I was shocked by this admittance and the fact that said it so randomly and with no warning or preparation. She had given me a children's book about grief which I actually found helpful at the time. But apart from that I found she wanted to see me as a pure innocent child, and when I expressed ugly emotions like cynicism, self loathing, she seemed disgusted and disappointed. She once sheepishly said that I was supposed to 'blossom like a flower' which I can't for the life of me understand what that means.
-- She's really old like probably 70 or 80.
-- I felt she was 'faking it' sometimes. . . like she had stock answers like 'What about your mother'. . and she pulled these out when she was bored
-- I felt she was constantly trying to vilify my mother, which doesn't sit well with me because I have a good mother overall.

Are these real issues or is this a natural part of therapy? Reading over what I've written, it seems like I'm angry at the therapist and don't have respect for her. I don't know why I see her in such a negative light, but i'm sure it doesn't reflect well on me.

Another issue is that I've had weird side effects recently. My CBT counselors said it's the CBT, and my doctor said I'm exhibiting potential symptoms that could be caused by Effexor. Tl,dr; He recommended I get checked by a psychiatrist for bipolar II. Its confusing to me because I didnt have these symptoms before I started the drug. So why do I suddenly have bipolar II now? Is there any reason to be skeptical or should I just trust my doctor and the psychiatrist he will send me to? the reason I'm nervous is that I've felt misunderstood by medical people in the past. My doctor is great and treats me like a human, but I feel wary of sharing all of this with the psychiatrist who might hold a strictly biological view of mental disorders which I have always disagreed with. In my case, I am quite sure that the CBT contributed a great amount to the weird symptoms, because they occured literally right after I had filled out a Thought Record and broken through a deep-seated mental belief that was holding me back for years ( not enough space to go into details here).

Anyways, what I'm looking for help with, is:
-- How should I proceed with my treatment? Should I go back to my talk therapist who I have issues putting my faith in? the alternative seems to be going through all the exhausting work of describing my past again with someone else. Is it worth it?
-- How can I find trust and faith with the medical view of mental illness? Basically how can i get over the fear of being dehumanized by the psychiatrist . (all this could have been influenced by my studies in sociology , anthropology, and communication theory. . . they opened a lot of discussions in my mind but I dont have any answers to these big questions so it's very hard to proceed). Should I get checked by the shrink?
-- I might be having an episode right now. Let me know if what I'm writing sounds crazy because I really can't tell.
posted by winterportage to Health & Fitness (9 answers total) 2 users marked this as a favorite
Find another therapist. You will get angry at your therapist from time to time or other things and you will work through them with your therapist. But you can only do that if you have a basic trust in the person and it sounds like she doesn't work well for you. And that's the only criterion that matters. I've been through a lot of different therapists. It can take a long time to find one that is really helpful. That's just the nature of therapy and therapists.

A psychiatrist is a medical doctor plus. Have you discussed with the doctor that you trust and respect your concerns about seeing the psychiatrist? Perhaps he can help reassure you. If the drug does have such side effects it could be contributing to your experience. It could also be the CBT. And it could be both. As someone with a chronic mental illness, I tend to err on the side of more is better. More information, more perspectives, more support. Believe me, I filter out the stuff that isn't useful. And I push back against people who don't seem to be hearing me and find other people to see if they can't change. Sounds like you are in a challenging situation now. Hang in there, we are rooting for you!
posted by Bella Donna at 1:04 PM on January 7, 2017

Leave your therapist. It's worth it to find a new one.
It's not either accept a medical model or a humanistic one - you can trust both and benefit from both.
CBT made me worse. It's not unheard of.
You could try the psychiatrist just to see what he recommmmeds.
posted by SyraCarol at 1:38 PM on January 7, 2017

my doctor said I'm exhibiting potential symptoms that could be caused by Effexor. Tl,dr; He recommended I get checked by a psychiatrist for bipolar II. Its confusing to me because I didnt have these symptoms before I started the drug. So why do I suddenly have bipolar II now?

Bipolar II is a label for a particular set of symptoms which can have any or all of multiple causes. One of those causes could easily be a reaction to profoundly powerful psychiatric medications, especially under various kinds of stress.

Nobody really knows how psych meds work. We have a pretty good handle on what they do on a molecular level, but the process by which that gets translated to actual experience is still sketchily understood at best. All we can say with any certainty about any particular drug is that it's been shown to be useful to people experiencing this or that kind of difficulty but sometimes causes this or that kind of side effect as well.

Responses to psych meds vary quite widely, and sometimes their side effects are as or even more troublesome than the condition the meds were prescribed in order to treat. Finding a combination of meds that's both useful and tolerable often requires several rounds of experimentation and fine tuning.

So it's completely plausible to me that Effexor might be usefully reducing your depression and anxiety but also giving you bipolar II. Working with a psychiatrist to find the most helpful combination of meds for you is absolutely the right thing to do.

I feel wary of sharing all of this with the psychiatrist who might hold a strictly biological view of mental disorders which I have always disagreed with.

No psychiatrist worth working with will hold a strictly anything view of mental disorders. Maybe I've just been lucky, but every psychiatrist I've met has been wise, humble and kind. If you find yourself working with one missing any of those attributes, dump them and get a better one.

how can i get over the fear of being dehumanized by the psychiatrist

You can start by asking any psychiatrist you're considering working with that exact question, and carefully evaluating their response. A good psychiatrist will take it seriously and not just blow it off.

I might be having an episode right now. Let me know if what I'm writing sounds crazy because I really can't tell.

Hang onto that attitude because it will help you recover very quickly if you ever do go crazy, which I don't think you are. During my own manic episode I never managed to marshal anywhere near the degree of lucidity apparent in your question.
posted by flabdablet at 3:08 PM on January 7, 2017

I might be having an episode right now. Let me know if what I'm writing sounds crazy because I really can't tell.

You seem like you have a lot to think about, but you seem to be explaining this all very coherently and cogently. But I, an internet stranger, am worried that you think you may be having some sort of episode. Is there anyone you can call to hang out with you and get their perspective?

I am worried you're alone and having these thoughts. Are you safe?
posted by yes I said yes I will Yes at 4:03 PM on January 7, 2017 [1 favorite]

I think most people have the same fear of leaving a therapist who isn't helping much. People stay in all sorts of situations (jobs, friendships, romantic relationships) because they've put so much in that they feel like the only way they can get the value equal to their efforts is to STAY in. (See: Sunk Cost Fallacy.) Yes, it may be exhausting to start over and give your background to a new therapist, but it also has the potential for bettering your situation if you work with a therapist where you have better rapport. Why stay with someone when it isn't working?

I'm reaching a point in life where 70 or 80 doesn't seem "really old" to me, but if you feel like a professional closer in age to you is one of the elements of building a positive therapeutic relationship, that's OK. There are all sorts of things that help us build therapeutic rapport: similar spiritual beliefs, same (or different) genders -- heck, I've learned that it's of no use to me to work with a therapist who doesn't watch television, because I think in popular culture metaphors. If you're looking for permission from random people on the internet to find a therapist whom you feel can better help you, well, you've got it.
posted by The Wrong Kind of Cheese at 4:05 PM on January 7, 2017

Yes new therapist and maybe new therapy model - CBT was never successful for me, the same was SSRIs weren't successful. I am on an SNRI now, and I am also doing Acceptance and Commitment Therapy which has been MUCH better in terms of my anxiety and PTSD.

One thing my therapist said at my last visit was that in times of severe stress, and immediatelt afterwards, it is totally unrealistic to assume any coping mechanism will prevent any and all meltdowns or 'episodes'. It may make them less difficult, less harmful, shorter, or whatever, but stress is stress! It is okay to respond to it.
posted by geek anachronism at 5:38 PM on January 7, 2017

A close friend of mine has bipolar II. Do a little reading on it to see if that matches your experiences before you started effexor. My friend's main 'up' symptoms look like: lots of energy, need for less sleep than normal, noticeably happier than normal, racing thoughts. This alternates with typical depression symptoms. I have classical depression. The main difference between us is that I was feeling poorly all the time, where she alternated feeling poorly and feeling great (not just ok, better than that).

If this sounds at all familiar, you should get checked out. If it is familiar from before the meds, then yeah you could have bipolar II. If it's familiar only post-meds, then it's time to have a discussion with a psychiatrist about whether a med change is warranted. If it's not familiar at all.. then probably your doctor is just mistaken.

Also, you can always ask them why they feel you need to be evaluated and whether they believe it could be a side effect of the meds before you see somebody new.
posted by zug at 6:18 PM on January 7, 2017

It's a good idea to change therapists, or at least meet with another one. You'd get a second opinion if you had a long running purely physical ailment and didn't have confidence in your medical treatment. Different things work for different people!
posted by kerf at 11:17 PM on January 7, 2017

Like they say above, there's no good reason not to leave your therapist. However, I suspect some of the problems you have with her aren't really her "fault." Communication across a large age difference can certainly be problematic, but I suspect you are not trying hard enough to communicate your point of view. The same hesitancy to quit and find someone else may be inhibiting you from speaking up when you feel misunderstood. You're allowed to say "What does 'blossom like a flower' mean?" You're allowed to say "When you don't talk like that, I feel abandoned--isn't what I've said so far enough for you to respond?" You're allowed to say "Why did you bring up your own situation? It's very different than mine!" You're even allowed to say "Telling you my complaints about you is frightening to me."

After you try and say what you want from her, if she doesn't figure out how to be the therapist you need, then it's time to find someone else.
posted by Obscure Reference at 8:00 AM on January 8, 2017

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