I need to get psychological help but I'm afraid of not having job
April 15, 2017 11:38 AM   Subscribe

I have come to the realization that I experienced a traumatic childhood, and the patterns of learned behaviors I used then are the ones that are wrecking havoc on my life now. I am young, educated, and bright (on the outside), but my life, health, relationships, work are spiraling to a low. I am afraid to lose my job and health insurance, but my anxiety and severe stress issues are getting in the way if not addressed! I need practical advice about what resources are available for treatment, what my rights are as an employee, what are my options if unemployed. Or maybe just a slap on the face.

I am in my late 20's and I've been dealing with various anxiety/depression symptoms for most of my life. I've been in various therapies, treatments, and medications for at least a decade, which has been up and down, but not that useful. But I'm realizing that if I don't get this under control now, I'll forever be in this loop where my emotions and behaviors cause ever bigger problems in my life. I already have shoplifting charge, an abortion, thousands of dollars of credit card debt, and am addicted to anything that'll help me numb my pain (drugs, relationships, food, sleep, shopping, etc, etc).

Funny thing is, I seem totally normal! Even high functioning! Despite the above, I went to prestigious universities for undergrad and grad schools (and somehow graduated both, but not without a lot of turmoil and tears and money...) I worked at as a researcher at leading medical centers and now work at a tech company in SF, where I get paid enough and have cushy benefits. Many mentors have supported me and believed in me because of the potential I show, and even at times, I do good work! But work came from so much stress and anxiety that I bestowed on myself, taking 10x as long as it really should, and I feel ashamed and not good enough afterwards, and then I want to hide and run away. And sometimes I do runaway to another field entirely.

I recently went through a job review where I sense my job is in jeopardy. But at same time, it's causing me so much stress. But I'll be stressed at any job. I also just moved to San frnacisco. I have no friends or support system. I don't know what to do. Please help online community to help me sort through the this! I've been at ho e for 1 week on vacation, but cannot face Monday without a game plan.

TLdr: I am in a conundrum: I need psychological help but need to keep job for health uninsurance. But I can't maintain job unless I get some treatment, which I can't get without health insurance.
posted by lacedcoffee to Health & Fitness (33 answers total) 6 users marked this as a favorite
Does your company offer an EAP (employee assistance program)? I'm in the process of getting 8 free therapy sessions through mine, which has been great. There's not much stigma in my office about that kind of thing, but even so, it's completely anonymous (nobody in my dept is notified that I'm doing this). Check your HR's website or call your HR rep to ask.

If you're in an acute crisis and need someone to talk to today, look at the MeFi There Is Help wiki for phone/online/real life resources.
posted by Ufez Jones at 11:50 AM on April 15, 2017

Have you looked to see what your insurance coverage is for mental health? It's usually a copay. Sometimes there's a limit to how many visits you are covered for.

If you lose your insurance (or, if your insurance is just crap) you can do what I do and avail yourself of your local university's psychology dept. practicum clinic. It's generally pretty cheap (mine's $10/session) Yes, you'll be working with students (masters and PhD candidates) but they're under supervision by an actual psychologist. It's worked out wonderfully for me.
posted by Thorzdad at 11:55 AM on April 15, 2017

Response by poster: Thanks for the replies. I realize I'm not being very coherent, so please be patient with me... what I'm looking for is intensive help dealing with trauma I've yet to resolve. I've had many many many therapists in the past. I'm looking for resources for someone who has already tried everything
posted by lacedcoffee at 12:12 PM on April 15, 2017

I think you should start by finding a therapist to go to see once or twice a week. This is a great place to start. You can keep your job and benefits while you start treament. This does not seem like an emergency to me and starting counceling promptly seems ok. You can discuss other options as you get to know your therapist. Your depression may be lying to you and telling you that you need in patient therapy NOW. But you may see a lot of relief eith regular old a couple hours a week and therapy and some reading/mindfulness.
posted by Kalmya at 12:20 PM on April 15, 2017

I want to ad, your work doesn't need to know you're getting therapy. Just go before/after hours or during lunch or say you have a medical appointment.
posted by Kalmya at 12:21 PM on April 15, 2017 [2 favorites]

Best answer: So, San Francisco may not be the best place to work through this sort of thing right now. Let me be blunt, working at a tech company in San Francisco is deeply stressful (even if they try to hide it with yoga balls and standing desks). Severe depression and anxiety is not uncommon here. Like you, your coworkers are hiding it, in search of outward career success or money, even the ones that are similarly successful and bright. The San Francisco of 1967 may have been peace & love, but the San Francisco today is 20-hour work days, tiny apartments with high rents and tight deadlines that drive people crazy.

Getting an undergrad degree and a grad degree from prestigious institutions, working as a researcher at a leading medical center, and as above, working for a tech company in San Francisco... these are some of the most stressful things you can do in terms of a career trajectory. If you talked to someone who said they suffered from severe anxiety who worked on the Alaskan fishing boats, served active duty time in the military and then became a high-powered stock broker in New York City, you'd immediately understand why they're anxious or depressed regardless of their childhood experience. That's a stressful life! Both yours and theirs!

Since it's virtually impossible to escape severe anxiety in San Francisco just from the stresses of living and working in the city, I think it will be difficult to separate, in therapy or other treatment, the anxieties you face from day to day stresses and the long-term anxieties you've grown up with due to the abuse you faced as a child.

It may be time to downshift. Work less, at something easier, in a place with a lower cost of living and a bigger support network. Literally take time for yourself, and if you've stashed away some money with those high-paying jobs, use it for a retreat or sabbatical year. Remove yourself from the grind of severe day to day stresses any way you can. See where your anxiety settles, and *then* work through the core issues. You'll know when - and how much - to engage in aspirational career stress after you've had a chance to work things out.
posted by eschatfische at 12:32 PM on April 15, 2017 [11 favorites]

kalmya said exactly what I was planning to.

If you haven't been to see a psychiatrist before, that might be a good place to start as they will be best able to help you find meds that work for you. I assume you've already been on SSRIs, but maybe not the right one.

For therapy, there are online therapist directories that list each provider's specialties. I'd look for a few that specialize in childhood trauma, and call each of them to get a feel for which clicks for you.
posted by duoshao at 12:34 PM on April 15, 2017

Response by poster: So I'd love to take a year off but I don't know how to afford it and my parents are my only support network but also my source of anxiety. What do I do?

And yes everyone, I currently have a therapist and have tried many many things in the past. Nothing helps.
posted by lacedcoffee at 12:43 PM on April 15, 2017

Best answer: How long have you been in your job? Are you eligible for Family Medical Leave Act protection? That might be the path to getting you time off for intensive treatment without jeopardizing your job (err, well, as much as a law can prevent that, anyway) while maintaining your health insurance. What does your employee handbook say about medical leave? Some companies are more generous than required by law in recognizing the need for medical leave.

Does your employer provide an EAP? They may be provide referrals to more intensive therapy options than once a week counselling, as well as helping you navigate the HR aspects of this.

If you're thinking thoughts like 'no reason to live' emergency in-patient treatment may be on the table.
posted by jacquilynne at 12:48 PM on April 15, 2017 [1 favorite]

Best answer: If you do lose your job, if for some reason they don't offer COBRA (continuation of benefits), you are immediately eligible for health coverage through Covered California, and if you have no income, your monthly premiums will be paid through an advance tax credit. Yes, the copays are higher when you're not on a cushy corporate plan, but it's not like everything becomes out of pocket.

If you have not already spoken with your therapist about temporary medication to address your extreme anxiety, I suggest you do so. It sounds like some phone calls to close friends and non-stressful family members might be in order as well.

I also agree that moving away from the super high-stress environment of the Bay might suit you better over the long term. If you really want to get off grid and not end up in massive debt, please check out numundo.org, indeed.com, or any other website that lists paid or volunteer positions. If you head to Central America for a while, any savings you do have will go a lot farther, and if you can get even a low paying job you can stay there for as long as you need to.

Best of luck. I know those feels :(
posted by ananci at 12:50 PM on April 15, 2017

Best answer: You need to go to urgent care or the emergency room and tell them that. If therapy isn't working, you either need medication or you need different therapy. Either way, you need some time off to recover. Go to urgent care. Go now!

If you have insurance, call the number on the card and tell them you need urgent help. If you don't have insurance, go to the urgent care at SF General and tell them what you told us, that you see no reason to live and are afraid of losing your job. You can also call 311 and ask them where you should go.

If your employer is located in SF city, they are required by law to offer you a certain amount of paid sick leave and either offer really good insurance or pay a chunk of money to health care on your behalf. California as a state also has generous paid sick leave requirement. A doctor can write you a note that you need to not be at work. You might not get a year, but you will get some time to recuperate and come up with a plan. The hospital will have a social worker who can help you interpret what you need to do to keep your job and take time off.

Also, what ananci said. You will always have care either via Covered California or Healthy San Francisco. Call 311 and ask for the Health Navigator if the time comes.
posted by blnkfrnk at 12:52 PM on April 15, 2017

Response by poster: Yes someone with a useful thing to say! Yes, we have medical leave, but I don't know how to navigate that. I feel HR is not on my side (I've had a HR situation and medical leave in the past at the same company). I've talked to EAP but they've never been helpful before. Are they my best resource right now? Also, I ...er... feel bad about taking medical leave when there's ...er... so much work for our team do do.....sigh
posted by lacedcoffee at 12:53 PM on April 15, 2017

You could start by applying for less stressful jobs in different locations, if a location/job change is a direction you want to go. It may not be possible to take a year off completely if you don't have the savings, but I can tell you from experience that going from a high-stress job in a city with a high cost of living, to a lower-stress job in a city with a lower cost of living makes an immense difference in your level of stress and gives you more time to take care of yourself.

In the meantime, you could use the Find a Therapist search to find a therapist who can work with you on managing your anxiety and making a game plan, if you don't already have one.
posted by bunderful at 12:53 PM on April 15, 2017

Response by poster: Also, no I am not currently suicidal. I need practical advice one resources I have available when I feel like I'm panicking, can't go back to work, have no support network.
posted by lacedcoffee at 12:59 PM on April 15, 2017

Mod note: Folks: OP has a therapist already. lacedcoffee: if you're in immediate crisis, please call your therapist, or a friend, or reach out to one of the hotlines on the There Is Help page - there are online chat hotlines if you don't want to talk on the phone. AskMe can't function as a crisis line. I'm leaving this question open for the moment in the hope that folks may be able to offer some helpful suggestions about a game plan for good next steps to take this coming week.
posted by LobsterMitten (staff) at 1:00 PM on April 15, 2017 [2 favorites]

Just a few things --

For past trauma, don't be too discouraged if things haven't worked before. It's both about finding the right therapist (interview several!) and being ready, and you probably weren't ready before.

I would start Monday on finding a therapist. You may want to downshift but there's no reason to wait or anticipate insurance issues. Just get started and trust that when things change, you will be able to adjust your plan. This therapist can help you with a plan.

I did downshift before I started "big therapy" and it helped at the time. I did not take all the time off though...everyone is different but for me having a job structured my time well. My career is different than it was before that but is just fine.

On preview: if you need help urgently, that is very fine to do. But from your list of coping strategies/issues I would gently suggest that while you absolutely deserve to feel better today, dealing with these things is a long-term type of work, and sometimes following a plan step by step (right now: 1. Find therapist 2. Make plan) is helpful for managing anxiety.
posted by warriorqueen at 1:00 PM on April 15, 2017 [1 favorite]

I realize that your problem is not really addiction, but there are some useful resources on how to navigate keeping your job but going to rehab that you might find helpful. They won't be 100% on point, but the gist of what rights you have, how to have the conversation with your employer, etc, is going to remain the same. If you work through the steps on a page like that, it might give you the structure you need to actually get started on getting help, assuming you don't take the advice to treat this as an emergency situation and go to the ER.
posted by jacquilynne at 1:02 PM on April 15, 2017

I think you should call your therapist right now and say you think you need leave. Have a gameplan for this.

If your therapy isn't working, find someone else or discuss with your therapist. I've had therapists refer me to other people.

Honestly your posts are reading like significant depression. Don't let depression make serious decisions for you. Maybe a new town (less stressful job away from parents and the bay area) is called for. You can build a new support network somewhere random. You can post about that too. But please talk any decision like moving or a big therapy program first. You really seem depressed and you need a doctor or therapist to help you dig out in a productive way.
posted by Kalmya at 1:02 PM on April 15, 2017 [2 favorites]

If you call or chat with the Peer-Run Warm Line, part of what they do is help you figure out the benefits you currently have to use.
posted by blnkfrnk at 1:12 PM on April 15, 2017

Are you asking us to recommend hospitalization? I understand why that migjt seem like an attractive idea -- away from work and parents, and indicative of a condition serious enough that you have no choice but to let everyone down, but as a practical matter, it's unlikely to solve your problems. Ask your therapist if they will refer you for inpatient therapy and see what response you get.
posted by janey47 at 1:14 PM on April 15, 2017 [2 favorites]

Response by poster: Just called EAP and they said they can't help but to calll HR. But HR is not on the employees side (admit it). What now?
posted by lacedcoffee at 1:28 PM on April 15, 2017

Best answer: If you lose your job - or even if you quit your job - San Francisco provides mental health services to the uninsured via the Healthy San Francisco program. Information is here. There are always mental health resources available to you in San Francisco.

That being said, public mental health services generally follow a blunt approach. They're there to keep people who are at severe risk of harming themselves or others medicated, hospitalized, or under watch. They generally aren't about healthy approaches to a stressful career and past trauma. They're about keeping people alive and out of the way of great harm. I suspect your concerns here are more nuanced.

In terms of taking some time off from a life that has become overwhelming to find an approach that works better for them, the people I know who have taken time off or abandoned a career have done it by:

1) Saving money fastidiously so they could one day leave their job for a time and relax or follow their bliss. Is it technically possible to still go to work? Can you cut expenses to the bone for several months to build yourself a small nest egg and then take leave? If so, this is often the best option.

2) Relying on the kindness of friends in another location to stay in a guest room or on a couch while they built themselves a life in a new location.

3) Engaging in a volunteer or overseas program where room, board and a stipend was covered to leave the country and experience a new culture.

4) Going back to live with their parents for a while, even if that wasn't a positive circumstance, to save money to move to a place and way of live that pleased them.

5) Researching and applying for jobs or educational opportunities in new cities, and who were then relocated.

It's hard for us here on the Internet - or even for a therapist - to know which of all of those might work for you. But if you are in severe distress, you can get help from San Francisco Community Behavioral Health Services at 415-206-8125. They will hook you up with the correct providers in the city regardless of your circumstance.
posted by eschatfische at 2:04 PM on April 15, 2017

Best answer: Hi!

I'm like you.
In a high achieving, multidegreed women doing well in my field in Chicago.

I'm now in my 30s.

In 2012 I had a PTSD trauma related breakdown . It happens. I had to take FMLA.

I chose a specialized hospital for trauma picked by me and my therapist. It happened very quickly. FMLA was applied for retroactively by my spouce while I was inpatient. I was hospitalized 21 days, followed by 2 months full PHP with accomidations for part time work and IOP for 3 months after that.

It was a really fantastic decision. I kept my job. HR grumbled. Boss grumbled. Nobody mentioned it aloud. When I came back I could work so much better .

Though the finances were difficult .To be clear, there were things in my life that allowed to go without my income for that time, and my HR policy was very considerate. They did my FMLA by hours which allowed for the part time extension. I accumulated vacation and sick time on FMLA and got a paid out occasionally even after I used all my days. There was a sick bank I borrowed some sick days from. I was a unionized employee.

Only real consequence was I did need psychiatric clearance for my next job which was embarrassing but that may have been the result of some other factors as well. I got the job. I'm doing much better now than then.
posted by AlexiaSky at 3:34 PM on April 15, 2017 [4 favorites]

Response by poster: I have a therapist who doesn't remember anything I say, but said I should get a dog. So now I have a lovely dog, paying all my money for a month-to-month rent so there's no way to save or pay off existing debt, too stressed/depressed/hopeless to figure out what to do next.

I don't have any good support systems because I could never maintain heathy relationships throughout my life, not even with therapists. I feel like the world is hostile and the heath system is ineffective. It feels like a cruel joke to give us only enough support to keep us alive and able to be docile members of society and economy.

I've been introspecting my entire life and have read extensively about psychology, the brain, development, attachment,etc etc etc... so I feel like I'm more qualified than my therapist who cannot remember my name to speak about my mental health. Psychiatrists have been stuffing pills down my throats for years and nothing makes me feel better. In the past, the day to day anxieties and stresses have been the main topic of conversation with my therapists, but in the past few months, I've come to realize they stem from the same patterns that are all based in a feeling of fear, shame, and unworthiness at the core.

I just need to know there's hope to actually get help that is helpful. That there are people who care. That there's a safe place for me. Because I don't see any hope right now.
posted by lacedcoffee at 5:30 PM on April 15, 2017

I'm really concerned that you don't think there's any hope for yourself right now. If you'd like to talk to someone, The Samaritans (212)673-3000 is a 24 hour hotline that you can call, even if you're not suicidal. I understand how overwhelmed you must feel, and you can start to break down address each problem individually, but not when you're spiraling. The first thing to do is talk to someone qualified to listen objectively, and that will hopefully help you feel less overwhelmed. If you want to change therapists, you can ask any healthcare provider for a recommendation, or search Psychology Today for a therapist under your plan. Please remember that there is defintely hope for you.
posted by Champagne Supernova at 5:58 PM on April 15, 2017 [2 favorites]

Best answer: Honestly, you're not wrong. The US health care system IS designed to leach all your money away and the culture where you work IS designed to keep you just able to work. Moving around makes it hard to maintain relationships and in general the world today is very insecure for people your age. No one you work for probably does care about you as a person, lots of doctors and therapists suck and pets are CRAZY expensive in the city! If you don't get yourself sorted out and happy soon, you will waste a lot of time. You are not crazy- you are pretty perceptive honestly. You sound really unhappy and self-aware and aware of how society looks at you as a single woman. Maybe you can focus your energy and smarts on beating the system and finding a life for yourself where you have a fighting chance to be happy: move abroad somewhere with a better health care system or work really hard to get married (people do this all the time for security and friendship) or move somewhere cheap and sunny and get a low stress job with good benefits and lots of time off and just work on making friends and having fun. You have this internet strangers permission to get off the treadmill of your life.
posted by fshgrl at 9:36 PM on April 15, 2017 [3 favorites]

Response by poster: Made a lot of calls yesterday, and though well meaning, no one seemed able to help me, besides transferring me to another line. I am way beyond "8 free sessions" or "let's talk for 5 minutes to a volunteer". Why is this mental healthcare system so fucked? I've been proactively crying out for help and trying to work through this for at least a decade, and it's really going no where, or maybe perhaps worse.

I have given up on forming healthy relationships, and have been desperately seeking a community my whole life, and never felt like I belonged anywhere. I feel like an outsider to even the outsiders.

Of course I'll never say I'm suicidal, because whos dumb enough to say that when all you'll is take me away and have an overworked social worker hold my hand and say that of course I matter in the world, when clearly, I can't even pay someone to care for me until I cry suicide in the first place.
posted by lacedcoffee at 1:39 PM on April 16, 2017

Best answer: Hi! I'm in the Bay and I experience longterm mental health struggles, too. MeMail me anytime if you want to chat.

You didn't mention what modes of therapy you have tried. Some of your wording strikes me as not just depression but personality-disorder-related (I am not a doctor, I am not trying to diagnose you, I am just somebody with personal experience here, and please excuse me if I am barking up the wrong tree). Particularly thinking you know better than your doctors. I know the feeling of hopelessness with our cruel healthcare system, but it's what we've got, besides religion and AA, so you do have to be willing to work with your doctors. If you do not trust your doctor, I recommend telling them that and working through it with them. You deserve a doctor you can trust.

I did DBT for my high anxiety and it helped me a LOT. I know other people with a range of diagnoses who have been helped by this type of therapy. I know the Wright Institute in Berkeley is a good resource for this. You could also look into what treatment there is for treatment-resistant depression.
posted by shalom at 3:14 PM on April 16, 2017 [1 favorite]

Best answer: To me, it sounds like you need a new therapist. It's hard, really hard. But someone above suggested looking for someone who specializes in childhood trauma. Once I got someone like that, therapy became more effective. DBT can also help. Learning the skills lets you cope with everyday stresses.

I understand the getting pumped full of pills thing. Can you make a double appointment with your psychiatrist (if you have one) to try to come up with a game plan. Cocktails can be huge (I'm on one of those) but they can be lifesaving too.

I'm sorry you're going through this. Mental health care in this country can suck. It sounds like you really need a break for day to day life. Based on my experiences I wouldn't suggest hospitalization. It's stressful in its own way. Take care and memail if you want to talk.
posted by kathrynm at 8:36 AM on April 17, 2017 [1 favorite]

Best answer: I don't know if this is helpful, but I just want to say that perhaps the only thing more stressful than living in San Francisco and working at a tech job is trying to get by in San Francisco without working at a tech job. I mean, the underlying fear and source of stress at work is that you'll be let go, no? So quitting preemptively would only remove stress by making the scenario that you're worried about into your present-day reality. If you're so not-afraid of it that you'd rather go ahead and do it then ... couldn't you just not quit, hold onto that lack of fear, and meanwhile save money such that if/when it does happen, it's even less worrisome? And then, in the meantime, you could go to therapy so that you're even more likely to be able to hang onto your job?

I'm sure this answer is naive as to the mental-health angle, but overall, I'd say hang onto your job and find a therapist you can work with. If they aren't remembering your name, then you need a better therapist.
posted by salvia at 1:04 PM on April 17, 2017 [1 favorite]

Response by poster: Thanks for the advice everyone. Currently still confused/sad/angry/insecure about life and the world, but I appreciate the inputs and food for thought. I do hope there is a chance of a reasonably happy or at least non-painful future for me, but who knows. Best of luck to others as well who find themselves in similar places in their lives... :-)
posted by lacedcoffee at 9:07 AM on April 20, 2017

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