Thursday, 8 July 2010

Relationships with professionals

I talked in my last post about relationships with friends etc being complicated. At the moment I am feeling like relationships with professionals are just as complicated - sometimes more so. I said recently that I feel like my relationship with L, or how I feel about it, has changed, and I wasn't sure how or why, and I have been thinking about that. I think it is probably partly because I haven't seen her as regularly lately - she has had to cancel several appointments, and she has also had leave, and that has left me partly not feeling quite as comfortable with her because of having been seeing her less, and also quite let down and rejected because of the cancelled appointments. I find it very difficult to trust people, and there are very few people that I do completely trust, and I usually end up getting very attached to those people, as I have with L, and so then when I feel rejected by them I tend to back right off, to stop myself getting more hurt. I do know that the cancelled appointments haven't been her fault, and that it has been because she has had other patients in crisis etc, but know it is related to other patients that she sees makes it even harder in some ways, because I feel intensely jealous of them - I suppose for being in the type of crisis that means she has to cancel all of her other appointments. It makes me feel like they are important, and I'm not - nobody has ever cancelled all their other appointments when I have been in crisis. It sounds very petty and childish, but that is the way I feel. I also seem to see her for less time now even when I do see her. I usually used to see her for about an hour and a half - then there was the period when I was supposed to see her twice a week (which only actually happened twice, as the other times she had to cancel the other appointment that week), and so the appointments were shorter, only an hourish, but there were 2 of them (or supposed to be). Now it has gone back to once a week, but the appointments are still shorter - the week before last was just about an hour, then last weeks was cancelled, and then this weeks was about 50 minutes. Again, I know it sounds minor, but it makes me feel like she doesn't think it is worth seeing me for longer like she used to. And then there is the whole making goals and setting targets thing that was brought up at my CPA, and that L has been talking about since. I just can't seem to do it - I can't think of any goals or targets to make at all, but L wants them to come from me. And I am constantly worried that if I can't think of anything, and I am not making any progress, then she will discharge me. It is a cliche, but I am terrified of being abandoned by her, I really am. And I keep wondering if that is why she is seeing me less lately etc - because she doesn't see the point when nothing changes and I don't make any progress. I think all of those things are affecting my relationship with her, because I am scared of being too reliant on her, as I think I am, and then being dropped, so I am subconsciously trying to distance myself a bit. Relationships with therapists and other professionals are really hard, because they are the people you are meant to be able to trust, and rely on, and be honest with more than anyone else, and yet there is always fear, for me anyway, that they will leave, or something will happen that will stop you seeing them etc, and it is incredibly hard to deal with that when it does happen, so part of you doesn't want to let them in, or let yourself get reliant on them, because then it hurts too much when they leave, or you can't see them anymore.

I have an appointment with my GP tomorrow. I have mixed feelings about her at the moment. I started thinking about my relationship with her after reading DeeDee's post on Mental Nurse about GPs and Mental Illness. I can't decide what I think about my GP. She is nice, she tries to understand, and when I was first seeing her and waiting on an appointment with the psychiatrist, she pushed for that etc. So in some ways she is good. On the other hand, I get the impression sometimes that she thinks I just need to pull myself together and stop being a mentalist, which is obviously not as simple as it sounds. When I saw her and was very suicidal she told me to replace the obsessive thoughts about suicide with obsessive thoughts about something else - I like dogs was her suggestion I believe... She claimed not to notice when I gained 25lbs, and yet recently when I mentioned my weight having gone down slightly (2lbs), she said she had thought I looked like I had lost weight. Last time I saw her she asked if I had had CBT - I said that I had and thought that it was patronising crap for the most part. She then asked me if there were any other types of therapy. Whilst she is not a specialist, I would expect a GP to know that more types of therapy than CBT exist. I said that DBT is usually the recommended treatment (in the NICE guidelines) for BPD, and she asked what that was. I gave a little explanation (bearing in mind I have never had any DBT myself) and she said she thought that sounded really good and would really help me. I explained that it wasn't available in our area, and her suggestion was that I become a DBT therapist so that I can run DBT sessions in our area?! This was one of the most bizarre suggestions I have ever had from any professional, ever. I think that she probably mainly has experience with IAPT, and I believe some of the people who deliver that do literally just do like a short course in basic CBT etc, which I can only assume was her reasoning for thinking I could become a DBT therapist. She didn't seem to realise that even if it was that simple, it wouldn't actually help me, as I need therapy myself - not to become a therapist for others. So she says some pretty ridiculous and unhelpful things at times. But she is nice, and I think she does genuinely want me to get better - she just seems to have very little knowledge past the absolute basics about mental health problems, and so I think doesn't know what to say a lot of the time. I have considered seeing another GP, but I do like her, and it is a small practice of 3 Doctors, and she is the only female. I am generally more comfortable with females, and one of the others I wouldn't consider seeing, as he was the first GP I ever spoke to about my mental health problems, back when I was 17, and was very unhelpful and unsympathetic. The other I think may possibly be the best where mental health is concerned, but I used to know him outside of the Dr/patient relationship (which is what happens when you live in a rural area!), and have therefore always felt slightly uncomfortable talking to him. But I don't know if my GP is right for me really, and I do sometimes feel like she doesn't grasp how desperate and suicidal I am feeling when things are really bad etc. I miss my old GP. She was the perfect combination of caring and knowledgable. Living where I do I don't have much choice in terms of GPs, and I do like Dr O, as I have said. But for example if L was on leave, and I was having a very bad, suicidal episode or something, and really needed help, the person I would try to speak to would probably be my GP, as I would rather speak to someone I know than a random CMHT member that I don't know, or even worse, my ex CCO, who really was a chocolate teapot. And I know that I wouldn't get anything in the way of help or suggestions from Dr O, except to talk to L when she was back. She wouldn't speak to the CMHT or Crisis Team or actually do anything. Maybe that is ok, and normal for GPs, and I expect too much after my old, fantastic GP. It just doesn't feel quite right. As I said, I have an appointment with her tomorrow, so I will see how that goes. I did think about seeing the GP there that I used to know, but if it felt too uncomfortable then I would then feel really awkward about going back to Dr O. Maybe better the devil you know?

Then there is Dr E, my psychiatrist. Again, she is nice, but is completely unwilling to try me on any medications, even though both L and I feel that I have been worse overall since coming off anti depressants, and I don't think would ever admit me to hospital or refer me to the Crisis Team however bad things were. So basically she does absolutely nothing, and therefore I am not going to be seeing her anymore, unless I want to for something in particular, in which case L will get me an appointment with her. So basically she is out of the picture now, and I am not sure how I feel about not being under the care of a psychiatrist, particularly since Dr O won't ever touch my medication, or rather she would never change anything when I was on medication - now I only have Diazepam there isn't much to touch I suppose.

I think overall I just have this feeling of being stuck, and general dissatisfaction at the moment with my mental health and treatment for it, or some of the time, lack of. I still think L is great, and I am still very attached to her, but for the reasons I talked about above I feel like things have gone slightly off with her, and given that she is now the only person I see about my mental health problems, this feels like a problem. I can't see anything changing for me with my current treatment, and that makes me feel very hopeless, as I can't cope with living like this, which in turn leads to suicidal thoughts. And that is why relationships with professionals are so complicated!


  1. I'm sorry things are rocky with L. It sounds like you have a really good relationship and I hope nothing happens to jeopardize that. Have you told her how you feel about the shortened sessions and canceled appointments? Maybe it would be worthwhile to tell her.

    I can't believe Dr. O won't put you on medication if that's what you think you need.

    I hope all is well, Bippidee. It's great to hear from you again.

    Wishing you well,

  2. I guess I can understand that as I do that too. If I think that someone I'm attached to is going to hurt me, I then start trying to convince myself that I now dislike them anyway and then pull away. It seems like it would be a shame to do that with L though, as you seem like you have a good relationship with her, despite a few bumps along the way, such as her cancelling appointments etc. Perhaps it could be worth bringing up how you're feeling with her? Relationships with professionals are complicated, definetely.

    Hmm, that is a bit unhelpful that your GP suggests you become the DBT therapist when you were discussing with her how you could benefit from being in DBT therapy yourself!

    Is the reason Dr E won't prescribe medication and won't admit you to hospital is because of the BPD diagnosis and the idea that people with BPD shouldn't be on medication and should learn to deal with crisis without an admission? If medication did help you though, I don't see why you couldn't be on something that actually benefitted. Could you see a different psychiatrist that actually does something to help?

    Take care,
    Cassie x

  3. I dont think it's cliche' or ridiculous at all that you are connected to C and fear abandonment. You seem to trust her and count on her and I think that's a good thing.