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Taking the Big Step


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I was dx'd as BP I about a year ago, and it was basically a year of bipolar rollercoaster hell.  Lots of meds changes, lots of nasty side effects.  Before I found my wonderful, lifesaving pdoc that properly dx'd me, I was having multiple panic attacks a day because I was convinced the FBI was spying on me in every car that turned the corner in my quiet neighborhood.  Before that for two years straight, I was the superwoman who got straight A's while working full time, going to college full time, raising two children, cooking and cleaning and taking care of a house, not sleeping, and still having time to make crafts.

Sure, I had some bad times.  So I saw a therapist.  They all wanted me to talk about the past.  Blame my problems on my horrible childhood.  Instill my sense of failure by staring at me, nodding silently, and watching the 45-minute clock while billing my insurance $100 an hour while I never got better.  Actually, I generally felt more depressed afterwards.

Fast forward to today.  I have a great pdoc who has saved my life with a proper dx and medications.  Yes, it's not perfect and I still have some big bumps in the road.  But now I have questions.  The philisophical kind.  Like "what if my children have bipolar?" and "How do I deal with the loss of creative feelings I have since I don't feel manic now?"  So my pdoc wants me to see a tdoc to discuss these questions.  He says I'm smart and I can best work out these questions with a therapist, since I already know the answers to most questions before I ask them.

But I don't like therapists!  I've seen too many who were freaks and losers!  What do I do if this one is a loser?  My pdoc referred me to this one specifically, but still.  What do y'all bipolar people get from therapy?  I mean, if you have a physical reason for your illness, what can talking about it fix?

Can you tell I have a scientific mind?  Anyway, I'm worrying myself about this, and would like some guidance as to what to expect.

Thanks!

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Heya gizmo,

(don't feed you after midnight?)

I hear where you're coming from with a scientific mindset.  Knowing I have an organic brain disease was (when I stopped being scared to death of being a patient) a palpable relief to me.  Because it means there's treatment.

I'm likely not the best one to be answering this right now as my experience with this therapist has been utter nonsense, as I've posted elsewhere.  But here's my take:

I found her, as a marriage/individual counselor, with a good-faith referral from my professional association, before I got officially diagnosed (although, come on, I knew damn well I was BP, but who in their right mind -- or wrong one, haha -- would seek out this dx?).

She thinks "psychiatrists are useless."  "Medications as an adjunct, if at all."  "Family docs [of which I am one, BTW] like CBT.  We [social workers] don't." (Those two are direct quotes.  Unsolicited quotes -- we weren't even discussing those things when she said them, they're offhand remarks!  DH can back me up.) 

In fact, she doesn't even buy my diagnosis.  And, from day 1 she's been nothing but pessimistic about our chances of staying married.

After reading some eye-opening threads about long-term therapy relationships turning sour, I decided to get out (egged on by fellow crazies ;) ).

What I need a therapist to do is:  Help me and DH come to terms with my diagnosis as BP.  Explain to DH in ways I never can what this means for our past, present and future.  Help me learn to handle these "feelings" I'm saddled with now that the overwhelming BP rage is not masking them all anymore.  Teach us how to talk to each other without the BP screwing it all up.  Guide me/us with homework assignments and up-to-date references (this chick told us to read that Mars/Venus crap, a bigger waste of $20 I can't fathom); I found the BP Survival Guide through a reference on CB.

When I see my psychiatrist I'm asking for a therapist he's worked with so things can be coordinated.  At least he/she won't think psychiatrists are useless if they work together.

Basically I recommend you give it a try.  But be a wise, I guess, consumer.  Figure out what you want from therapy, list out those questions you have.  Ask questions like you're hiring this person for a job, because you are.  You evidently have experience to draw on, so work from that.  And take hope from the referral coming through your psychiatrist, who seems to know you well.  With any luck, you'll be a good match.

--ncc--

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The Kay Jamison quote on therapy helping her to make sense of a life disordered by biology is the best short answer I know to "why talk about a medical illness?" 

I do it because:

I feel that my relationships to my husband and children are profoundly threatened by this, and, just tactically, I don't always know how to go about managing and fixing that;

I've been able to do some focused thinking about personal goals and creativity -- what I do and don't still have, and how best to act on it -- without spinning in circles;

I'm not beyond having compliance/acceptance problems if the symptoms are really bad, and I need to work out emergency checklists; and

if I don't do it, I tend to try to do all of these things in conversation with family and close friends, and that's just not fair to them -- it's too needy, and too much information.  I still depend on these people a lot, but therapy clears some space in our relationships so they can be about something other than my problems.

I'm glad this therapist is a referral from a doctor you trust.  It's possible the therapist won't "get" you and you'll have to move on anyway.  I like your attitude (and your doctor's) about going into therapy to firm up what you already know.  And I'm glad the roller coaster is slowing for you a bit.

best wishes,

sg

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Hey, I'm not warm fuzzy chatter.

But my Pdoc said she wouldn't see me if I didn't do talk therapy.  She was careful to recommend a good fit of therapists for me.  An older male who has been in business many years. She knew right off that I wouldn't tolerate a young inexperience type who was learning the trade on me.

The therapist has been most hepful during the long months while waitng to find the righ med cocktail, and then wating for it to take hold. Corrected poor thougth processes and misperceptions of situations, suggested coping strategies, talked me thru the suicidal and SI urges, and if nothing else summarized and reflected my statements back to me so I could understand what I was thinking.

Earth shattering break through?  No.

Scientific?  Yes.  Study after study is showing that meds + talk therapy work better than either alone. 

I do think the need for talk decreases as I get better. I am only going once every two months at present. 

good luck.

a.m.

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I have had some very very very bad therapists.  One who thought my depression was caused by "repressed memories" from childhood.  One who just kind of nodded and said "how did that make you feel?"  One who suggested my irritability would level out if I went out, got drunk, and fucked the first guy I met. 

I have also had some excellent therapists.  One who plodded slowly through a set book of issues which were actually relevant to some of my problems at the time.  One who prayed for me.  One who loved action plans and checklists and short-term goals.  One who was pedantically trapped in unstructured insight-based therapy, but was pretty good at what he did (if only that had been what I wanted).  And others.  Always others. 

Find a therapist who is flexible.  Find a therapist who talks.  Find someone you can talk to for a fair chunk of the fifty-minute hour without feeling awfully out-of-place.  Find someone who recognizes your biological disorder and will not tell you that every behavior has a natural, situational cause. 

My therapists right now -- due to strange circumstances, I have three -- all recognize my bipolar and ADD diagnoses, all know when my meds change, and all keep in mind the possibility that my behavior might be off-kilter because of a bipolar mood swing.  At the same time, they refuse to let me off the hook for my actions just because I'm officially crazy.  They help me talk through the emotional aspect of life with bipolar, help me figure out how I can fix the fixable, and help me feel slightly less despairing.  They're good.  They're helping me function better.  I think there might be someone out there who's good for you, too.

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Most of my reading boils down to a good tdoc is essential to managing MI long term.

I've been absent from the boards for months because life got really bad, but also because then I started tdoc...3rd visit was this morning.  I was specifically referred to her because pdoc thought she'd be a good fit.  That history is to support this story:

Soon after 2nd visit, I was hit with an extremely bad trigger situation.  I was able to recognize the beginning and (barely) focus on one of the skills she taught me to manage my emotional response.  I still didn't handle it well but I'm getting more stable on meds and if I can do it once, I can do it better the next time or the time after that or the time after that.  It was a hell of a night later as I worried over it all in my head trying to make sense of what has never made logical sense about my own craziness.  I was able to talk to tdoc about it today, past & present, and that's something that I haven't done in my life with anyone because I do NOT talk about emotional issues. 

With the support network that I'm learning to build, I think I can manage and I have hope now.

Good luck!

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Well, I finally had my therapist appointment today.  It was... like a first date.  I think she's nice, she treats other bipolar patients, likes my pdoc, absolutely insists I stay on my meds (I have this whole pathological hatred of pills, and taking 5 a day combined with the BP voice telling you that you don't need them can get loud sometimes), talks back, doesn't want to discuss the deep recesses of my childhood, etc.

How do I know all this?  Because I was so nervous I had the equivalent of verbal explosive diarrhea during the session.  What the hell happened to me?  I've been so dead to the world I can't string two complete sentences together at home, and I blab on and on to this stranger I don't know?  I was actually embarassed at how much I talked and told her about myself during that measly 45 minutes. 

At one point, she just kind of stopped and stared at me like she was amazed.  I simply told her, "I'm an analytical person, and I've had lots of time to think about these things."

But anyway, she seems pretty open and I'll probably keep going to her.  I'd like to bounce all the guilty and worrysome ideas in my head off her instead of my tired husband for a change.  Probably be a nice relief for him.  And it would be nice to have a backup for my next depressive episode, because I can use all the help I can get.

I guess we'll see what happens in two weeks.  Gotta love the holidays, messing up schedules!

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Most of my reading boils down to a good tdoc is essential to managing MI long term.

I definitely agree with this.  I saw my last tdoc for 2.5 years and he was excellent at helping me deal with life issues in the context of being bp.  Particularly in convincing me that I do actually have assets and can contribute positively to society (self esteem is a big issue for me).

I'm currently not seeing him, partly for financial reasons, but largely because I have been seeing a great pdoc since April who spends time every appointment discussing my Issues with me.  I have some pretty major ones at the moment, including marriage difficulties and the horrors of getting my med cocktail right.  Since I'm seeing her once a week at the moment, I find that I don't need the extra sessions with the tdoc.

Good luck though - I hope you keep on clicking with your new one.  I particularly liked the fact that you said she talked back - my last tdoc was like a blank slate - just sat there and listened, which was NOT what I needed.  I need feedback, dammit!

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