Tag: therapist

Alka-Selzer and therapists

by Midnight Demon, posted in blogging, depression

I nearly just had a heart attack…not a real one just an OMFG YOU GOT TO BE F*N KIDDING ME one. I started word and instead of it loading right away, I got an install thingy, meaning it had to reinstall itself. HUH?? I know I uninstalled office 2013 earlier in the day, but that should not affect 2010, should it? Well, crisis averted because it seems to be working.

I have had a rough day. I again spent most of my session talking to my therapist about writing. Apparently she thinks I should be working on another book, like now. My first one hasn’t even been edited or published and she wants me working on another. Well, that’s a NO. I don’t think she gets that I am not a writer. Sure, I blog and I think I am good at that, but I am not a writer per se. Anyway, all this stress about writing books is making me want to drink. I would actually drink but my stomach is doing flip flops after the burger I had for lunch and my head is spinning because I haven’t worn my glasses for a couple of hours. HELLO Alka-selzer. Because isn’t that what you take when you have a headache and stomachache? I actually like drinking it. It is fizzy and usually tastes good. And it works fairly quickly.

Tomorrow I get to deal with my father. Got to take him for his blood work. I called him today and he was a little irate. Tough shit. I know if I was him, I would opt for a different medication but unfortunately he is (well, will be) 82 and has liver problems so it is kind of limiting what meds he can be on. So I have the aggravation of dealing with him every week for his blood test, unless I hear back otherwise. Did I mention I hate my parents this week?

I usually don’t deal with them on a regular basis. But since I have been getting up early, before 9 am, I have been dealing with my mother. She hasn’t learned that don’t talk to me before I am fully awake yet. So when she tries to have conversation with me that early, I am usually in a pissy mood. I am not a morning person. Today wasn’t so bad because I was actually really awake when I woke up from another weird fricken dream. I don’t remember it but think it had something to do with farms. I made coffee today that was a little stronger than the cup I made the other day. It was good but unfortunately, once I brought it to my room, aka freezer, it got cold really fast and I couldn’t finish drinking it. I had half a cup and that seemed to do it’s magic. It got me working on one of the manuscripts that I have been crafting…and I found that I repeated myself multiple times. UGH. Each time, I worded it differently so that made editing soooo much easier, NOT. I talked about it in therapy. Wrong thing to be talking about. She didn’t understand my dilemma. It didn’t piss me off but it just annoyed me because we were again talking about writing, rather than other stuff.

I don’t know what exactly I wanted to talk about today so I just let her lead me to what she wanted to talk about than what I wanted to talk about. We also discussed writing a book about my therapist experiences. That would be one interesting book. I have had 12 therapists over the course of a ten year span. She is number 12, and she almost wasn’t. After number 11 left me, I wasn’t sure I was going to go back to therapy. I was tired of therapists leaving me. Granted not all 12 left me. A couple I fired, but the majority moved on from their practice and so left me behind. It hurt every time. And that is a big hurt when you are trying to let someone in, you do, and then they leave. Moving on is harder because it just closes you up more. Today, my therapist can’t imagine her life without me in it. And I can’t imagine my life without her, though there are times I wish I could sever the connection. But after 13 years of dealing with her, I think she is a permanent fungus. There is no cure for her.

cabin fever and psychoanalysis

by Midnight Demon, posted in blogging, depression, mood disorders

I have been feeling cooped up as I have not gone out of the house, with the exception of picking up my prescriptions yesterday. That didn’t take too long, I might have been out of the house for at least thirty minutes or so, maybe less. Today I had no intention of going out but I have been stuck in my room because I really don’t want to eat all the food in the house. My appetite is crazy and I don’t know why that is. I know part of it has to be because of boredom. I am also alternating with eating and sleeping so I know the depression is still kicking around. But I need to get out of the house. The weatherman say a storm might hit tomorrow. He isn’t sure. Guess it depends on the currents and such. I hope it doesn’t as I really want to get out of the house tomorrow and have a jittery latte. I will be a bundle of nerves when I see my pdoc. That will be great! My not having coffee or caffeinated drinks is making me intolerant when I do have them.

I also have been craving alcohol, and not the rubbing kind. I have been having a drink here and there but now I seem to want it every day. I am really craving whiskey and I know it has to do with the increase in seeing my father more. He brings out the best in me. I tolerate him by drinking. Bad habit, I know, but I very rarely drink otherwise. And being stuck in the house is not helping the craving. I also want gin. I actually bought a whole bottle but only have had a sip of it. I like these drinks straight up, with no other liquid or juice, unless it’s other alcohol. Then it’s ok. I am not an alcoholic. I drink infrequently to be one. But when I do, it’s like the flood gates open. I drink until I get sick and then I stop drinking. I am a binge drinker, I will admit to that. I don’t know how I am going to handle dealing with my father’s illness and taking him to the doctors every couple of weeks for his blood test. I just want to drink. If I can’t kill myself, I will drink. I still owe my adoptive father a shot when he passed away. I will drink to his memory too.

Because I was bored out of my tree, I decided to pick up “the Savage God” and read where I left off. It was interesting reading this book when you are not so suicidal. Things actually make sense. Though the author was talking about Freud and his ideas of suicide and some other psychoanalyst I have never heard of, the concepts were valid in a weird way. Now I have not been in the psych field long enough to really give Freud his due. I did study psychology as an undergrad but it has been years since psych 101. I do actually plan on taking the course again so I can refresh my memory a bit. The author was also talking about the ego, superego, and Id. I forget which is which so I was just going by what the author was saying. And that is why I need to take this course again. I will break down and go to the community college down the street from me. I just hope I can enroll as a non-degree student. Or even take it as a, damn I forget the word. It’s when you take a class but you don’t receive credit for it. I know I will remember this at two in the morning. GGRRR.

The gist of what I am trying to say was that Freud had no clue about suicide anymore than anyone else. He used the term death instinct but there was really no basis for this as other people who followed him found out. So the big psychoanalyst couldn’t explain suicide like he could his other theories. I find that a little disturbing but I really want to read his work on melancholia. I am fascinated by Freud. I once read his book on humor. It was dry as all hell and at times difficult to follow but it showed the analytical side of why people crack jokes. It was very interesting. Course I have no idea where that book is today as I would love to re-read it. I think it is my only book about Freud. I hope to own his collections one day. Though I know there are not that many psychoanalysts in the world today. You are more likely to find an eclectic therapist than you are a traditional psychodynamic one. Though there are other modes of therapy. You have cognitive, cognitive behavioral, and then behavioral therapy. There are others, such as humanistic and something that begins with an “ex” that I always forget but they are not so much around here.

I have an eclectic therapist which means she doesn’t focus on any specific form of therapy but knows of the different kinds of therapy. It helps to have this type of therapist because you can talk more freely, I think anyways. And there is less therapeutic interference such as homework and such. Usually, I am bringing material to her more than she brings the material to me. And usually I give her the homework. HA how is that!

relentless

by Midnight Demon, posted in blogging, depression

Not having a good day. I had an extremely long day and all I want to sleep but I am afraid of having these weird dreams I have been having. Some of them I remember, others I don’t. Like there was one where I was back in my hometown and there was an aquarium where my old hangout was. It was more like the petting pool that is at the aquarium where you can touch the fishes and turtles and stuff. All the while I was there, I was supposed to catch a boat but this aquarium was in the way of the gangway. Really weird.

Then today I find out it’s Jason Aldean’s birthday, which is really cool but weird that he is a year younger than I am. The closest cut, which is a song that is a favorite of the artist of the day or a greatest hit by someone years ago, played his song Relentless. I bleared it on the speakers and immediately thought of my therapist and how she is never going to listen to this song because we don’t meet in person, though I am planning on seeing her Tuesday, if conditions are right. Conditions are I wake up early, I feel like going to the next town to get my sister’s car, and also feel like driving 30 miles with no precipitation on the road. I don’t know if I am going to be able to go because Monday is supposed to be a snow storm and the roads might not be clear enough come Tuesday. It usually takes a day after a storm for the roads to be clear. Also, one time when I saw her I went into a snow bank while making a turn. So that is why I hesitate. I was ok and so was the car but it was just scary losing control of the car and having no where to go but a bank of snow. So I will see what the weather will be like and then make my decision. This winter has been really brutal so I am expecting a very hot summer, which I hate more than the cold, frigid temperatures. Heat and I do not get along. I rather be in -10 degrees than 90+ any day.

The most I can do to get my therapist to get this song is to send her the lyrics. Then she will have some idea of what I am talking about. Course the song is mostly about her. I just associate the song with her.

commitment to living

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Seeing as I have been suicidal the past few weeks, sometimes intensely, other times not so much, I thought I would talk about the dreaded “no suicide contract”. In an article by Rudd, Mandrusiak, and Joiner (2008), the authors describe that there is no empirical data that proves a contract is a deterrent to suicide anymore than say pinky swearing (my words not the authors). In these times where suicide rates are going up rather than down, it is important to have something in place so that the therapist and client feels comfortable sharing the suicidal feelings without always resorting to hospitalization. The authors in this article promote a “commitment to living statement” as way to facilitate 1) identifying roles, obligations, and expectations of both clinician and client, 2) communicate openly and honestly about all aspects of treatment including talk of suicide, and 3) identify emergency services usage when client cannot contain the agreement.

This agreement seems to me as a good way to start any conversation of suicide but it also feels like it is an informal consent contract. It doesn’t really focus on a suicidal behavior tracking plan like the Suicide Status Form. All it does is explicitly states that the client make a commitment to living.

I was reading this because I thought it was a unique contract but now I am thinking that it is not. It does however, give the clinician and client a time focused treatment plan that I think all therapists should have with their clients so that if something is not working, it can be changed so it does work. In my experience, I think that this would be helpful for my therapy but I think it might be too late for that as we are no longer seeing one another face to face and this contract requires a handwritten statement to be made.

My therapist and I have reached another impasse and I think sometimes that having a break is beneficial. It gives me time to think things over. I also think that if I had the inclination, I would bring this article up again with her and see what she thinks of it to help my suicidal tendencies. But I am not sure about the whole commitment to living aspect of it. It does seem to me that something needs to give and she needs a piece of mind that doesn’t include me telling her I want to kill myself every week. The biggest thing on the commitment statement is that it allows for goals to be set. In my twelve or so years of being with the same therapist, I don’t think we ever have set one goal in treatment. Usually I was the one to come up with a treatment plan on how I wanted to be treated. That was fine until I ran out of gas and ideas. But what would setting a goal after all this time be like? I don’t know as I have not really thought about it. My therapist doesn’t give me homework, other than possibly blogging about something she has in mind for me to work on. We generally have an unspoken agreement that I will call her should I think about acting on my thoughts to harm myself. The most I have done is text her, a lot, to let her know I am having a hard time with my thoughts. Usually this happens during the long weekend when either she is away or when we have a long few days between sessions due to the weekend or holidays. I try not to text her so much but she seems to like me keeping her in the loop so I do it to sort of please her. Plus it tells her that I am still alive so that eases her anxiety a little.

An example of the Commitment to Treatment Statement is the following:

I, ________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including:
1) Attending sessions (or letting my therapist know when I can’t make it
2) Setting goals
3) Voicing my opinions, thoughts, and feelings honestly and openly with my therapist, whether positive or negative but most importantly my negative feelings
4) Being actively involved during sessions
5) Completing homework assignments
6) Taking medications as prescribed
7) Experimenting with new behaviors and new ways of doing things
8) Implementing my crisis response plan when needed
I also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss this with my therapist and attempt to come to a common understanding as to what the problems are and identify potential solutions. In short, I agree to make a commitment to living. This will apply for the next ____ months at which time it will be reviewed and modified.
Signed_____
Date_____
Witness____

To me, as I have said before, this looks more like a basic agreement contract to therapy than it does for specifically suicidal thinking/behavior. The reason I bring it up is because most clinical therapist do not have such specific language in their agreement and I think it is important to work together in treatment. A client should always have a say in treatment, no matter if it is in psychotherapy or medicine. With a little modification of the wording, this statement can be used in any clinical scenario. It is basic and to the point. Clients should be active in the care but sometimes that is just not possible. I mean if you have a throat infection, you are not going to argue with your doctor about treatment. You will want the antibiotics so that the infection doesn’t spread and you get sicker (if it is a bacterial infection to begin with). But it gets trickier with something complex as say diabetes. This blog doesn’t deal with that so I won’t say anything further about it. Just know that you should always advocate for your say in treatment and ask questions about why you are being placed on medication or physical therapy or whatever your doctor prescribes.

Basically, I have to agree that this commitment to treatment statement (CTS) is better than a “no suicide” contract because it (CTS) allows open discussion and collaboration of treatment whereas the no suicide contract will just state that the client will not kill him/herself.

The second part of the CTS agreement is the Crisis response plan (CRP). It states:

When thinking about suicide, I agree to do the following:

Step 1: Try to identify my thoughts and specifically what’s upsetting me
Step 2: Write out and review more reasonable responses to my suicidal thoughts
Step 3: Do things that help you feel better for at least 30 mins (examples can include, trying to sleep, play internet games, brush hair 100 times, write in a journal, listen to music, etc)
Step 4: Repeat all of the above
Step 5: if thoughts continue, get specific and I find myself preparing to do something, I will call XXX @ 555-555-5555 or suicide hotline
Step 6: if I cannot reach above I will call my therapist or psychiatrist
Step 7: if I am still feeling suicidal and I don’t feel like I can control my behavior, I go to the ER or call 911 (or whatever the local emergency line is for your country).

Either plan is effective even though neither have been empirically tested. The CRP I have used in my treatment and I have found it useful. During one of my recent hospital stays, I actually gave out the CRP to other patients hoping they would benefit from its usefulness.