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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Annabelle Smith on January 21, 2011, at 22:53:50
I had made until today for my session this week, and was counting down the hours until the release and safety of salvation arrive. But I missed a call and found a voicemail from my therapist on my phone telling me that due to the snow and ice we have had that he couldn't make it into the office. He offered me a phone session in its place. When I heard the voicemail, I felt enraged. I totally understand my therpist's situation and would not want him to come to the office in these conditions. But I was still so angry-- I think it was a general anger towards the uninvers and him, insofar as he is part of the whole. I haven't scratched since September, but today I was so angry and hurt that I went into the chapel and scratched-- not too hard or deep, but marks to externalize what is internal and can't be expressed anywhere else.
He called me later at 4 to start our phone session, but I felt awful and couldn't get started or say anything. He told me that he had offered his other clients with whom he also had to cancel today, the opportunity for a session early next week and so wanted to extend the same opportunity to me. I decided to not do the phone session today and instead meet in person on Monday late afternoon. From now to Monday afternoon feels like an infinity-- I am sitting alone in my tiny room tonight. I have bought and am eating chocolate-covered pretzels and have been drinking coke. NOTHING will soothe. I was hoping that writing about it on here might help.
I hate that I am this obsessed about my therapist. It is *literally all I can do to make it one week from one session to the next. After I leave a session, he usually feels present with me for a day or two. But after the second day, and definitely after the third, it is like he is gone. I can't even remember what he looks like. He is absent. And then, at the next session, it often feels like we are starting over from scratch, as if the last session never even happened.
I need to know how to make it until Monday. But I can't keep doing this-- wanting each day to rush by just so I can get to my next session.
I am in bondage-- but I can't leave! That would be what I can't stand.
All I can see is time running out.
This is miserable.
Posted by Dinah on January 22, 2011, at 8:39:30
In reply to session, posted by Annabelle Smith on January 21, 2011, at 22:53:50
Do you have any medications for when you get very anxious or upset? I find that as needed medications keep me from dipping too low in mood. It didn't do me much good to spin out of control, and it wasn't fair to those in my life.
Have you told your therapist how you react? It might be something you two need to work on, to have a strategy on hand for those inevitable times when he can't see you.
I had my therapist make me a relaxation tape, so I could listen to his voice when he wasn't around. I don't know that I used it that often, but it was nice to know it was there.
Posted by sigismund on January 22, 2011, at 15:57:44
In reply to session, posted by Annabelle Smith on January 21, 2011, at 22:53:50
This will likely sound very strange, but anyway....
When you are not with him, when his image is no longer inside you and you are in darkness, can you not feel that you are suffering for him and that is the work you are doing?
If I was your father I would have sent you to a convent :)
Posted by sigismund on January 22, 2011, at 15:59:56
In reply to Re: session, posted by sigismund on January 22, 2011, at 15:57:44
Any reasonable person might wonder why we are made like this.
Posted by Annabelle Smith on January 22, 2011, at 18:05:39
In reply to Re: session, posted by sigismund on January 22, 2011, at 15:57:44
>> "When you are not with him, when his image is no longer inside you and you are in darkness, can you not feel that you are suffering for him and that is the work you are doing?" >>
That might make sense, Sig. Thanks. Again, it makes me think of my therapist as God.
Sometimes I feel like a convent is the only place I could ever function.
Posted by Annabelle Smith on January 23, 2011, at 14:52:39
In reply to Re: session » Annabelle Smith, posted by Dinah on January 22, 2011, at 8:39:30
Thanks, Dinah.
No, I don't have medications to take-- we have discussed this briefly, but are going to try to work through it using other means, such as the distress tolerance skills from my DBT workbook.
We have discussed this briefly, but I find my attachment issues with him very embarrassing and difficult to bring up-- this is not his fault; he accepts everything that I say in a compassionate, non-judgemental way. But I still feel such shame. The embarrassment, which I feel so often, is not one of just *blush, blush, but is a feeling in which the very ground of my being feels threatened, where I feel the need to disappear and escape what will feel to be an intolerable destruction.
I have created my own relaxation "tape." My therapist knows about this, indirectly, but again, I am embarrassed to say it openly. But for nearly a year now, when the intense need is there, I listen to his saved voicemail messages on my phone. I don't know how long I am going to have to do this, or God help me, if the phone breaks. But especially in moments of nearly intolerable loneliness and agitation at night, I can listen to his voice and feel soothed enough to fall asleep somewhat peacefully. It helps.
Posted by Dinah on January 23, 2011, at 20:57:32
In reply to Re: session » Dinah, posted by Annabelle Smith on January 23, 2011, at 14:52:39
Is your therapist opposed to medication?
Posted by Annabelle Smith on January 24, 2011, at 15:23:49
In reply to Re: session » Annabelle Smith, posted by Dinah on January 23, 2011, at 20:57:32
No-- but he has told me that in many cases, he doesn't feel strongly either way about medication. If I wanted it, he would work with me in that capacity; if I didn't want it, he would work me in that capacity and try to find altnerative ways to cope and heal.
I'm not keen on taking medicine for many reaons that I won't go into here. I do think there are some cases where it is necessary, but I don't think this is one.
Posted by emilyp on January 24, 2011, at 22:22:19
In reply to Re: session » Dinah, posted by Annabelle Smith on January 24, 2011, at 15:23:49
Annabelle
I obviously do not know your concerns as it relates to medication. I realize everyone has their own reasons.
But based on how much pain you seem to be in - from what I have read on this board - you might really be doing yourself a disservice. It is really hard to work on things in therapy when the anxiety is through the roof (from my own experience). I can imagine it is also very difficult to be productive in therapy with some of the other feelings you experience.
I don't think medication is the answer for everything. Therapy is clearly important. But often medication can provide you some relief such you are in a position to really benefit from therapy. And since you are feeling some time pressure, this might be the time to consider medication.
Again, I realize not everyone is comfortable with medication. I am not saying it is the only solution. But it might be part of yours.
Posted by Solstice on January 25, 2011, at 6:29:22
In reply to Re: session » Dinah, posted by Annabelle Smith on January 24, 2011, at 15:23:49
I don`t think of myself as `for` or `against` medicaation. Rather, I think of myself as beinbg `for` healing. One thing I know for sure is that it is impossible to think productively - impossible for our mind to work `for` us, when we are consumed with pain. Based on your posts, you are in intense pain the majority of the time. It might not be possible to engage in therapy in a genuinely productive way until after the intensity of your emotional pain has been quieted.
Ask any medical doctor, and they will tell tou that addressing physical pain is the single most important thing they can do to facilitate physical healing.
When you are in pain, all of your resourses, your energy, is devoted to relieving the pain. It`s a survival mechanism. If the pain does not subside, you have little available for growth and `higher` matters of functioning like healing. It`s not just you - it`s that way for everyone. So Annabelle, I think you will help yourself a LOT if you would find a good psychiatrist and at least discuss it with them.
Solstice
Posted by annierose on January 25, 2011, at 9:11:08
In reply to Re: session » Annabelle Smith, posted by Solstice on January 25, 2011, at 6:29:22
I agree with the other posters. As only outsiders, we read the distress and pain that envelopes you. And you say things like, "I can't live this way". If medication can provide some relief so you are able to be more productive in therapy, there is no harm done, only more hope for healing.
We all say this but it's true, you wouldn't deny yourself an antibiotic if you had an infection. Or insulin. There is no shame in medication.
You hold back from sharing with your therapist how much pain you are in between sessions. HE doesn't know that agony you deal with every single day.
Posted by obsidian on January 25, 2011, at 21:14:10
In reply to Re: session, posted by annierose on January 25, 2011, at 9:11:08
I agree, and while I tend to hate my medications, I have also been grateful for them at times. There is a heck of a lot of emotion coming up. Sometimes you just need a buffer.
It doesn't have to be a forever thing.
Posted by Annabelle Smith on January 26, 2011, at 19:48:31
In reply to Re: session, posted by obsidian on January 25, 2011, at 21:14:10
Emilyp, Solstice, annierose, obsidian, and Dinah,
Thank you all for responding and offering me your thoughts-- it really touches me that you care.
I am trying to consider what you are saying, and after the (make-up) session that I had on Monday evening (the one I was referring to anticipating in the original post), I had to consider what you were saying a lot more closely. On Sunday night, I felt like I was going to have a great, breakthrough session on Monday (I could just FEEL it). But I was so hyped up for it, that I could scarcely sleep four hours (and that all broken and light) the night before. In the session, I was exhausted, painfully self-conscious, not present (I think the word is dissociated), felt fake and blank, and the words that I would try to say *literally couldn't come out.
I have this thing about speaking. I think there was a time a long time ago when this wasn't an issue. People have always told me that I talk fast, but I was never *afraid to speak. I always get mad, still when people tell me that I talk too fast-- I think it's more of an anger that is a deep feeling of hurt. It's getting better, because I have to speak a lot in what I do, but sometimes it is like I can't. Some things happened to me that I won't go into here relating to speech when I was in elementary and middle school. I can't stand to hear my own voice, and I never know when it will happen, but about half of the time, I feel like I am not even controlling the words that come out of my mouth-- my words are controlling me. This leads to a feeling that of being trapped inside of my own head-- I have so many things I want to say, but am trapped in silence. I feel stuck in the silent prison that is my head. When I sit in a therapy session and fall silent, just watching the clock tick by, I feel despair. I feel fake, trapped, and the one person who can help me isn't able to even know the distress inside. I think he knows the most from the posts from here that I have occasionally brought in to share with him. But this isn't just a therapy issue-- it interferes with EVERY aspect of my life. No close friends, no romantic relationships-- ever, f*ck*d up interviews, and terrified to give presentations/teach, yet everything that I want to do with my life requires that I be able to speak in front of others and do so well. More than that, I just want to not be alone anymore.
I need to find my voice and own it.Last session left me in despair. I ended up calling my therapist early the next morning, and that helped a little to diffuse some of the distress. But it is still there.
But finally, with regards to medication. I built up all of this to say that last session hurt me so much that after I left, I seriously considered making an appt with the dr. pronto for medication. After last session, I left with feelings of a deep despair and thoughts of suicide were back-- after being in session-- because of the hell and being trapped in silence and false being that I described.
Appreciating and taking seriously all of your comments, I still do have concerns about medication. I am going to try to be honest enough to share a few of them here, if that is OK.
First, as I researched, I came across this info on a website at a DBT treatment center:
"Medication is a useful adjunct to many clients in DBT. In these cases clients need to have a prescribing physician familiar with DBT. We do not provide medication at the Center. If medication alone has successfully treated the problematic symptoms, though, there is no need for DBT. If not, it is important to understand that in undertaking DBT, DBT becomes the primary treatment. If medication side-effects interfere with effective participation in DBT, it is usually a good idea to postpone enrolling in DBT or to discuss with the prescribing physicians the pros and cons of continuing the medications at their current dose."
I am in DBT with my therapist for, the name we have decided upon, while accepting all the limitations and constructions that come with any label, Borderline Personality Disorder. In my research, I have repeatedly found what this website says: in DBT, DBT is the primary form of treatment, not medication. In fact, with BPD, medications often play a very small role. While there is much depression and anxiety present, it is not something that can be fixed with a medication, as the reasons for it reside in relational patterns and habits of perceiving the world. My depression is rarely just blanketly "there"-- it comes from an event, an encounter that has failed.
Also, referring to the quote above again, I don't want any possible medication side-effects to interfere with the precious DBT work that I have to do right now. I already feel pushed for time (although my therapist encouraged me last time that I have all the time I need). I don't want to mess up what I have going now. I want to continue working on.
Let me be clear that my opposition to taking medication has nothing to do with my perception of it as "weak" or "giving in." Not at all. But it is terribly confusing to me. I am already struggling within the infinite maze to make sense of my experiences; the medication would throw in an element that I can't make sense of-- like an external factor that I can't incorporate into my understanding of my experience.
I just want to feel again. I want to be able to cry. The sadder I feel, the less able I am to actually cry tears. It just gets trapped inside. I want to be able to weep, to be creative, to hope, to laugh, to smell the fresh air, and be fully present in each moment. I feel dead now. That is sometimes why suicide seems like a small step-- the real death is already here. Sometimes I feel, but it is back and forth. I want to be able to feel, and I do fear (not without, again, much research) that medications take the edge off, so the bad isn't as bad, but the good isn't as good. Dammit, I rely on what is f*ck*ng out the roof good when it is here. Moments of feeling goodness, bliss, enrapture make life possible for me to continue. I am afraid of becoming a zombie and feeling nothing.
Finally, one more note-- about envy. The closest person that I can be honest with-- the person whom I feel as though I can share my issues in therapy with (the only friend who knows I am in therapy...and she is significantly older than me and has been through many years of therapy herself of which I am jealous... I don't have the kind of time that she had), the person who I might be able to call in distress-- after my last session on Monday, I HAD to get out what I was feeling. I couldn't call my therapist after I had just left. In fact, leaving each time has something to do with the despair. Nearly every time I leave his office, I feel nearly sick, it is despair. I texted my "friend," and she never f*ck*ng responded. I have seen her several times since-- we sat one seat apart in a meditation session tonight-- and except for a brief hello (barely that), she ignores me. I want to say F*CK you! I hate you. Why did you not respond to my text? Why do you just continue on in your rosy little world when you know how I am feeling-- you won't even take 10 minutes to talk about it. But I just smiled and waved back. Dammit. I really do hate her. This always happens. This is why people cannot be trusted. When I take the step to trust someone and they tell me that they will be there for me, they back away and leave.I am afraid that if I let myself be honest with my therapist, he will do the same thing.
Posted by Annabelle Smith on January 28, 2011, at 15:11:05
In reply to Re: session, posted by Annabelle Smith on January 26, 2011, at 19:48:31
I am sorry for my tone in the last post. I just felt so overwhelmed and pissed in the moment. I have seen my friend since, and we have had a conversation, though it has not been very much therapy-related. I think I have just burned her out with my therapy problems.
I bet that-- in my refusal to take medication-- you all feel like I am being stubborn, non-sensical, and am ignoring all of the help that you and others are trying to offer. I am not ignoring what you are saying, and I am *actively seeking help.
I am trying to understand from your perspective; I hope you can understand from mine.
What happens to me in sessions is so strange. I think the word may be dissociation, but I find myself having a session but not being present. Last session, I couldn't say much in any depth. Each time I would try to go beneath the surface, I hit a wall of embarrassment that feels unbearable to cross. And so I backed away and sat in silence.
We talked about my attachment to him. He asked me what feels so bad about it to me. I am not sure I know but we shirted around what I think it is. He kept asking me what would be so wrong with me being attached. I didn't say this but the truth is that it feels inappropriate. My feelings towards him aren't romantic-- I know they aren't. But it is still a deep love, a love that I think may be more primal and may be deeper than romantic love. Because it is so deep, I feel like I am doing something bad, but I can't help how I feel. I am stuck.
There are other things that I need to talk to him about but feel embarrassed to do so. The deep sense of embarrassment and feeling of shame is so deep that I don't know how to pass through it.
And so I often remain silent. And waste time. And feel distressed.
Posted by violette on February 1, 2011, at 16:10:26
In reply to Re: session, posted by Annabelle Smith on January 26, 2011, at 19:48:31
Sometimes people have unconscious reasons for refusing meds, other times it is what it is. Can you dig deeper, think of any other possibilities that might be under your radar?
If you have Borderline, then medications are used to treat the co-occuring axis I symptoms anyway and would be the same for anyone who is not borderline.
Prozac and Effexor seem to be the best choices for these symptoms, at least initially. There's something about an overactive nervous system that seems to respond better to these 2. Don't have any research as it's been a while since i've checked, so its mostly my opinion though you might find this to be true in papers out there.
I don't know anything about DBT other than what I've read and heard, but I do know that medications can help or hinder any type of therapy.
If medications work, DBT could be viewed as unnecessary due to waiting lists, maybe people who might need it more, maybe people with severe cases. DBT could be potentially helpful for many (as people who have done DBT often say this regardless as to whether they are borderline). People learn life long skills from this therapy, Plus people who are borderline can be high functioning at times or for years, then regress only in times of severe stress or with relationship losses or other emotional triggers. Either way,I don't agree with the statement below. Hope you make your best judgment.
"Medication is a useful adjunct to many clients in DBT. In these cases clients need to have a prescribing physician familiar with DBT. We do not provide medication at the Center. If medication alone has successfully treated the problematic symptoms, though, there is no need for DBT. If not, it is important to understand that in undertaking DBT, DBT becomes the primary treatment. If medication side-effects interfere with effective participation in DBT, it is usually a good idea to postpone enrolling in DBT or to discuss with the prescribing physicians the pros and cons of continuing the medications at their current dose."
Posted by Annabelle Smith on February 2, 2011, at 16:51:42
In reply to Re: session, posted by violette on February 1, 2011, at 16:10:26
Thanks, Violette. I appreiciate you sharing.
"If medications work, DBT could be viewed as unnecessary due to waiting lists, maybe people who might need it more, maybe people with severe cases. DBT could be potentially helpful for many (as people who have done DBT often say this regardless as to whether they are borderline)"
I really do not like the idea of taking medication and then DBT being unneccessary. I am not saying that I don't want to get better. You mention people who might need it more-- well, I want help too. I really just want one realy human connection where I can share things I haven't been able to share in over 13 years. I have turned inward upon it all until I feel like a phantom. Medication won't fix that.
You are right. Medication might help some of the depression and anxiety. My therapist said that in my case, it might be worth an experiment to see what happens, but he doesn't think it is my final answer and he won't make me do it.
Posted by Dinah on February 2, 2011, at 19:57:15
In reply to Re: session » violette, posted by Annabelle Smith on February 2, 2011, at 16:51:42
Medications don't need to be something that blocks off your feelings and makes therapy less useful.
Medications can be something that allows you to feel what you feel, but without becoming nonfunctional.
I use as needed medications, except for some lamictal prescribed primarily for migraine prophylaxis but which also has some mood stabilization benefits. I have on hand Risperdal (my personal favorite) and Klonopin. I'm rather finely strung, and while I can be functioning ok and feeling fine sometimes, with too much stress I melt down into a puddle and don't function at all. Only when the pain interferes with my life do I take the medications. I have a responsibility to my family, to my employers, and to myself, to remain functional.
My as needed medications in no way interfere with my therapy. I don't even generally take them the morning of therapy. What they do is keep me from falling too low. Sometimes feeling the pain is productive. Sometimes it's counterproductive. It's the responsibility of the patient, guided by mental health professionals, to decide to take (or not take) medication in a way that works best for them.
It doesn't appear, from the pain you frequently express, that your pain is productive at this time. But that's an assessment for you and your therapist/pdoc to make, when they are fully aware of the circumstances. Perhaps you could discuss with them different medication alternatives and what they would mean in your life.
Posted by Dinah on February 2, 2011, at 19:58:30
In reply to Re: session » Annabelle Smith, posted by Dinah on February 2, 2011, at 19:57:15
I suppose what I'm saying is that medications don't need to be embraced or rejected in full. They are a tool. It's how and when you use them that determines their effect.
Posted by Annabelle Smith on February 2, 2011, at 20:25:47
In reply to Re: session, posted by Dinah on February 2, 2011, at 19:58:30
Thank you, Dinah. I appreciate your thoughts on that-- you give a nuanced perspective. You get away from an either/or approach. That seems like a helpful way to look at it.
This is the end of the thread.
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