Across and Inside my Universe

Unsafe

Well, I'm not safe.

Lability is uncomfortably high (I hope I'm using the term correctly).  My state of mind, my emotional perspective, keeps shifting so much that any decision I make, even fully believing and commiting to it, I can be doing just the opposite five minutes later (or half an hour, hour, etc.).  The place from which I am interacting with the world from, feels as though it's on a mess of shifting tides and currents.

Part of me thinks, well, isn't this just weakness of character, not being able to stick to anything or operate from a stable state of self or being or mind or whatever?  That word, stable, though, is part of the key.  The whole shifting currents thing, is another.  I'm NOT STABLE right now; I'd not call myself UNstable in a crazy, psychotic way, but  . .. well, basically what I've described above.

It is tempting to fall into the trap of thinking, hey, since I'm seeing this problem, and acknowledging it, doesn't that mean I'm functioning well enough to be or feel safe?  I've fallen into that trap before.  While identifying this stuff, prioritizing it, taking some actions with it, etc. are positive and functional, healthy things, the very nature of being so . . . well, volatile isn't quite the right word, I'm not going to lash out in an extreme way (although I guess suicide and other things actually are pretty extreme) at anyone else (hrm, I've been highly irritable and rather snappish, which I've been not pleased to have acted out as much as has been, the last few days; it has been uncharacteristically frequent and drop of the hat.)  I've been quite reactive and on a short fuse, not even necessarily being aware of having a short fuse, until I snap at my husband.

I've been irritable and snappish before, without the high lability; mixed states suck.  There is more here than just that, although mania and depression certainly make matters rather worse . . . 

I have therapy tomorrow, and I don't know if my psychologist will recommend the hospital.  We've already taken some familiar and not so familiar steps, around here.  Any excess medication my husband has hidden.  A step taken once before, for a time, that I've asked of him again, is to not leave me alone at home for three hour+ stretches.  Two hours feels like it'd be kind of rushed for anything extreme, but that may be because I'm particular.  I hate to scare him like this, but on the other hand it feels the responsible thing to do.

So, he may need to stay home from church on Sunday.  This would carry us to next Wednesday, when I'll be home alone for most of the rest of the week.  If I am still highly changeable/feel like my behavior could turn 180 in the blink of an eye/feel like my mania or mixed state or whatnot is pushing me to danger, then we'll have to probably hospitalize me or figure something else out.  I am REALLY hoping that I'm not like this, then.  It usually has only ever lasted a few days, 3 or 4 tops, but I had this a week to 10 days ago for 4 days or so, and now again and it's just rather scary.

I dunno, maybe I'm a wuss and not taking responsibility, when I say that I can't seem to be able to say that what I decide right now will be the place from whence I could reasonably still be operating an hour from now, etc.

The pull to reckless and harmful, serious things of a variety of types is strong, although I am currently fighting them.  Some things you can't come back from, and some you maybe  shouldn't (okay, definitely stuff to bring it up tomorrow in therapy.)

Edit:  This talk of lability, and danger, and unsafeness, and my assessments thereof, are based mainly on how my psychologist has assessed me most recently last week when discussing the same kinds of things, as well as in the past, the few other times that it has been this bad (all since early 2012, really).  Things I'm saying here are based on concerns he's discussed with me about my safety and stability and such when I'm in this/these states, having experiences as I've been this week and being all over the place, and stuff.  My safety has been a major issue and concern to him, in many of the ways I posted about here, and some things I haven't posted.

Edit:  Also, I do have upcoming appointments with my psychiatrist, later this month and then in August as well, since my urologist cleared me for going back on psych meds/back to the psychiatrist (I know one doesn't necessarily mean the other but he has pronounced my kidneys fine, after a CT and a cessation of the most distressing symptoms . . well, I may need to check one more thing with him, but he did clear me.)  Still, I may be contacting her sooner, by email I guess, if my psychologist thinks I need to go to the hospital.  Maybe her emergency nmber would be better, I don't know?  I' ve left a message on there before.

Do What Hurts the Most to Improve What Hurts the Most

Or:

No pain, no gain.

That's a little black and white, but since running from pain is what I do best, learning to just sit with my pain, heck, learning to recognize when what I'm doing is a defense or running from pain, is pretty much where I'm at alot of the time.  Yes, even after all these years of therapy.  I was sooo un-self-aware back then, and therapy's helped me alot through the years, subjective though my opinion might be.

So, to improve in areas where you social anxiety bell starts ringing, you need to at least approach that bell and face some of your fear, and learn that you can deal with that situation, without retreating, in order to make gains in that area.

Sounds so simple, doesn't it?

When spelled out intellectually like that, it does, but feeling it is quite intense and often difficult.  Still, I've gained some sense of efficacy in some areas I needed improvement in; oh, how many more there are!  

A month ago, when my husband started physical therapy after his arthroscopic shoulder surgery, I went with him and saw the therapist who'd been my physical therapist several years ago.  He's the owner of the place, so quite capable (or seemed so to me).

He asked after my recovery, and was unpleasantly surprised/startled to find that my total knee replacement recoveries have turned out so poorly.  He kind of quietly threw out there that perhaps some strengthening, exercises and such, could do improve things quite a bit, if not solve the problems entirely.  He expressed his sadness that I was in such lasting pain and again seemed to think that improving strength would help.

I found myself out of sorts after hearing this, and as I lay in bed that night I realized, "He's saying that I don't have to be in pain; that there is something I can DO about it."  I felt anger, because how does he know I haven't worked hard?  I have.  I felt frustrated, that he would just assume that something COULD be done, because I've had to come to terms with being in pain alot.  I felt anger that he was dangling no or less pain in front of me, if only I would CHOOSE it, the implication being that if there was something I could do to improve my situation and I didn't, then I was CHOOSING to be in pain (or at least, in as much pain as I am).  I did realize eventually however that most of this was how I felt upon hearing or pondering what hea said, and wasn't necessarily what he said, or meant.

I chose, last week, to get over myself and have my husband ask him what I could do (the holiday being kind of nuts, I couldn't make it to many of his physical therapy appointments, although I could have done better than I did).  Why let pride stand in the way of possible improvement?

What the physical therapist suggested is standing up and down out of a chair, like I used to do at physical therapy and at home during recovery, using legs only no pushing up on the arms of the chair with my hands, etc.  He also said I can use a pillow in the chair if I can't stand up without using my arms without it.  To that I thought, "What, does he think i'm THAT weak?"  I can actually stand up from a crouch now, and it was less than a year ago when I couldn't do that; I'd gotten in a crouch and was stuck (it felt like I had no way to make myself fall over either, weird as that sounds, so I could get up from there, so I felt trapped and feared getting in a crouch again).

However, a week or two ago I crouched without thinking about it, and got out of it myself (with agonizing pain, naturally, but still I did it.)

So, I'm going to start doing three sets of 10 of these, several times a day, with a day off in between here and there, as when you are strength training I know the muscles sometimes need time to build back up.  Or something.

I've got an office-style chair that I can and do usually keep set really low.

The thing is, standing up without any assistance from my arms, or from setting my legs farther apart, has the pain hitting a level 7 during the whole muscle-pushing process.  Level 7 is alot.  So, to stand there and do it ten times in a row, rest for a minute or two, do ten more, rest, and 10 more . . . well, that's alot of pain.

Still, I don't, I really don't, want to let pride or complacency get in the way of possible improvement, so an extra heaping of pain it is, and I'll note down every two weeks how my pain is, of differing types in my legs, and do this for three months at minimum.

I'm not optimistic, but  I guess we'll see.  If there's only a minor improvement, is that enough given that I'd likely have to keep up with some level of strength-boosting/painful activity to retain this improvement?  It depends on how much, if any, improvement we see.

**

On another note I don't think messing w/meds is a good idea.  I'm actually desperate to have higher Lamictal to be a barrier between me and aspects of my mania that I had forgotten how they felt, partly because I couldn't understand how I could feel that way and still be me; however, I am starting to be reminded.  I was going to go back up on Lamictal but just upping it a little, made the urinary system a touch worse, enough so that I just cannot make myself go back up; it'd be like having to use a hammer to squash a bug on my hand - I can't make myself do it.

I really, really don't want to get off the med, but I really, really can't live with the developed side effects either.  Just, this isn't me not wanting meds, I tried to make it work for a long time.  There's practically no choices left, of mood stabilizer (lithium has such a high side effect profile? is it? that I'd really like to let my kidneys and bladder heal up and have some time where I'm not constantly worried about my health and side effects; however, the mania isn't just going to go hide under a rock.  Ugh.)

What's My Problem?

Why am I so upset about the group therapy?

It's not the end of the world if I'm faced with something unpleasant about myself, however awful it feels or seems.

It's not the end of the world if I feel as though I was manipulated by the psychiatrist.  Would it have been better if she hadn't done so? (If she actually, intentionally did; manipulation is in the intent.)

Sure.

Is it any surprise to me that she's insensitive, dominant, strong in her opinions, outspoken about them, and has a definite idea of what she feels is best?

Put that way, no, no it's not.

It's never fun to be receiving such things, from a doctor no less, and even more difficult to bear, from a psychiatrist.

Still, I can discount some of her "authority" by thinking of the above things that should not surprise me anymore.  Why would I put alot of weight on what someone like that says, if it's not specifically medically related?  Ie, if it's not medical advice she's giving me but therapeutic (both are medical in their way but I think you know what I mean).

So regardless of how she was, as I discussed in my last post, I can follow the chain of thoughts that led me to a very bad place, to a very . . . difficult view of myself to approach, let alone investigate.  That makes it hard for me to discount anything, and so leaves me with a feeling similar to the picture up above.

I feel kind of like it would be healthiest for me to set aside this difficult, painful view of self for awhile and just keep on plugging away, step by step, at improving.  It's hard though because this thing wants to pull out the rug from under me and just bring everything crashing down.

Perhaps I'll gain some more perspective and/or distance from it in therapy tomorrow.  I feel like I've already gotten a little, as I'm not flailing around emotionally, as much as I was.

Still, I really do not need another really bad thing to think about myself, when I get suicidal, to pile on top of the other really bad things I think about myself.

Life however doesn't care how many bad things come your way, it just goes on.  So I need to as well, hopefully putting this in a better place.

I Herd You

I went to what I thought was a support group that my psychiatrist runs, for adults with AD(H)D.   It turned out to be group therapy.

She had an agenda, that she guided and directed the group through and towards.  She lectured from time to time; she drew conclusions and presented them as "the" way to feel & think about things.

In some ways, she was as indelicate as a bull in a china shop; however, there was also a sharp mind behind the questions, conclusions, directing.  She knew what she wanted us to think, and she took us there, by leading, pretending to guide, snapping at our heels like a sheepdog if we weren't quite drinking the Koolaid she was dispensing, by running us into the pen she had decided was where we needed to be.

There wasn't much support, and what support she gave to others in the group eventually morphed into her adapting what they'd said, into her agenda for where she wanted things to go.

Now, before this group session I'd had an appointment with her, which went fine, since we'd made some things clear last time.  Such as the notion that I am my own person, in my own life, and I am the best one to decide what works for me, and not her.

That obviously applies to anything, but when you go to a group thing like this you try to leave yourself open to learning something, gaining some support, or insight, or something . . . by the time you realize there's a sheepdog at your heels, you've gone a ways down a path that may not be for your good.  You do your best to keep from bursting into tears through the rest of the appointment, to keep from going where it is that the sheepdog is pushing you, but you are already falling down that mountain.

So there's a knife in my heart, and you'd think it'd be relatively easy to pull it out by discounting the source; obviously she's not a sensitive nor observant nor supportive nor respectful therapist.  Why would one give much weight to what she wants, what she says?

It's not that simple, however.  I wish it was.  See, the things I thought and felt, the places I went to, the conclusions I found, well, there's a train of thought and feeling that I had during this process.  Both she and the group were stimuli in that process, but I can still follow the path in my mind and heart that led me to a really bad place.

I am having difficulty discounting that, erasing it, setting it aside, or whatever.  I can't un-think how I got there.

I feel it's a therapist's professional responsibility to not command the direction of things, to not make conclusions AND present them as what IS, to not herd you towards a prticular destination.

A good therapist, even if they had a particular destination in mind for you, even a general one, that they felt was healthier for you, they would discuss things, perhaps point out paths you might not have considered, discuss how you feel about them, objectively weigh the pros and cons, but they'd never take the reins and grab you and pull or shove you down a path of their choosing.  That's part of what I mean by herding.

I feel like a therapist should respect the vulnerability of the patient(s) and use care and concern, among other things, when working with them.

To not just willy nilly, but purposefully, push patients down a path that they don't know where it's going, and by the time they have some idea they are so distressed that just about anything at that point will settle in and try to take root . . .that is bad therapy, at the least.

Of course, I'm an adult and not just turning myself over to go wherever she wants, but I didn't realize until after this happened, how vulnerable going to something like this makes you, even if you are nervous, scared, and wary.  I had made a decision some time ago to try to learn what I could from whatever the source, sometimes having to set aside my feelings about the source and just consider the infomation.  This, too, made me vulnerable, besides all my other psychological/emotional issues.

I ended up in a very bad place.  Much of that is me, but the therapy itself and the manner of it, is also a big factor.

I'm starting to think, now, that what she said in our amicable appointment a month ago, that whatever she says, it's my choice what I decide is useful for me, is partially an excuse for her brash, forceful "therapeutic" manner.  That she can excuse quite a  few things by saying or thinking that the patient can chuck it all out, if he/she wants. 

If this is so, then she's at the least rather irresponsible.  The people who go to see a psychiatrist are often vulnerable in a variety of ways, and many are not equipped to fend off or sort through her forceful assertions, her "therapy" if you will.

So I think that her expecting her patients to be confident enough and self-aware enough to discount what she says if it's not best for them is disingenuous at the least, irresponsible and harmful at worst.

Pop Culture References in Psychotherapy

Some pop culture items are so . . . pervasive, they've permeated our society to a depth that one could reasonably expect someone else to understand a general reference to it; ie, Mickey Mouse, "Here's looking at you, kid!" and others.

It's not guaranteed, but most people have a frame of reference.

There's others that are so widely popular and have been mass-marketed so much (Star Wars) that it's pretty rare, though not unheard of, for people to not understand the, "Luke, I'm your Father" reference. Although when it comes to the geekier references (Dungeons & Dragons, sci-fi, fantasy, computer nerd stuff like Tron) it really depends on the "audience".

Still, sometimes in therapy the best analogy you can think of to help illustrate something you are trying to convey, involves a pop culture reference. More often on my, the patient's, part, but occasionally, though not often, my psychologist will do this as well.

For example, when Kung Fu Panda (the first movie) was out in theaters, and had been out for a couple months, I finally saw it, and the moment at the top of the stairs when Master Shifu asks him why he stayed through all the abusive treatment Shifu had dealt out to him, well, Po's (the panda) answer deeply connected with me and I almost started crying (yes, this IS Kung Fu Panda I'm talking about). I thought, someone in Hollywood understands ME.

Now, it's not that important that ANYONE in Hollywood understand me; anyone understanding me at all is excellent! Or, AWESOME as Po would say. Still, you see all sorts of people portrayed in various shows, movies, etc., and if you never see yourself there, you feel like maybe your are too odd, wierd, defective, etc. to ever have a person with any traits similar to you be portrayed.

Now, do I define myself by what's seen in the media? HELL NO! It's just, that moment of connection with Po was a sincerely touching moment for me, and while Po may not necessarily be the personality that many people would want to identify with, well, there it is, I do. My therapist had, actually, seen the movie, and so we spent about half the session talking about the movie and the things I related to in it, silly as that might sound to some, it felt productive, helpful, and validating to me.

On the other hand, if your psychotherapist is relating a pop culture analogy to you, about something you've just told him that prompted him to think of this analogy, and the reference is the movie Fatal Attraction . . . well then maybe you're in trouble. Not with him, mind you, but if your behavior, feelings, thoughts, anything you report brings up a Fatal Attraction reference to his mind . . . well, it seems like a scary thing!

Of course, since I've never SEEN Fatal Attraction, I didn't really get it; he seemed quite surprised that I hadn't seen it. I've heard certain types of references to it so many times I know a little about it just through those; enough to know having what one just told him in therapy being related back to me as a Fatal Attraction reference, is not . . . a positive reflection on me.

Now, he's objective, and I don't believe he was using the references to JUDGE me or anything like that; rather to point out the extremes that certain thought patterns can take you to (not that I think I had done or said anything Fatal Attraction-like, but then, how would I know, since I've never seen it?)

So, he took several risks in using those references, and the fact that I hadn't seen the movie meant his analogies fell kinda flat. Then again, some of mine have as well.

I just know that one probably really needs to look at ones' self and alter ones' course of thought or behavior, if said courses of thought or behavior are inspiring Fatal Attraction references in ones' therapist.

Overheard Psychotherapy - Intensely Complex & Painful Fallout

Well. If one is going to overhear a loved one's psychotherapy session, wouldn't it stand to reason that various random elements in the universe might align to coincidentally allow the overhearing of probably the worst possible session for that person to have overheard?

Just kinda figures, doesn't it . . . .

Imagine, if you will, that events have happened in the previous week that have brought out a surprising (to you) amount of anger, with all sorts of angry thoughts peppered with demeaning and insulting things about a loved one. I am not proud that, in anger, I have thought some really terrible things. I am far from proud, in fact, as you'll see.

SO, in an effort to expunge this intense but over-reactive anger from me, in an effort to see things in a less blown out of proportion way, in an effort to gain a healther perspective, in an effort to process the anger and come to a realization of how I ACTUALLY feel, rather than the extremes to which my mind sometimes goes when angry . . . in all these efforts for good and positive things, and more besides, I opened up in therapy in a way that is often hard to do; I let it all out, the anger, the things I thought in the extremes of my anger, every negative, unpleasant, unkind and even cruel thing that went through my head. Some of these things are things that I know are sensitive areas for this loved one; this makes everything about this situation WORSE. Except for the fact that I recognized I didn't want to hold on to these extreme angry thoughts and feelings; I wanted to see, think, and feel a more healthier, reasonable view.

Well, imagine my shock when, a while after I'm home from therapy, I find out that this loved one overheard all but the first 10-12 minutes of my session! Imagine the feelings of, "But therapy is supposed to be PRIVATE!" Imagine the feelings of being betrayed by the loved one, by the therapeutic environment which was not sufficient to keep what was said in the office, confidential, the feelings of horror when I started to run through my mind the things I had said, and, as if in a disembodied third-person overhead cutaway view, I could "see" the office and the environs outside it, with no roof, and see everyone involved in this situation. Imagine the intense pain I began to feel as I thought of how this person might or could be feeling upon hearing the vile, angry things I was spitting out in therapy . . . . the pain that pierced my heart like a knife, realizing that, though it shouldn't have happened, it shouldn't have become public, it HAD been, and that I had deeply hurt this loved one, whether it "should" have happened or not.

I had all sorts of complex feelings, like, "But I didn't do anything WRONG; I was only trying to do the best by both this person and myself, because I had intentions to in the near future discuss the feelings of anger that had come up about them, but I first wanted to air them in therapy and gain a more healthy view as I would NEVER in a MILLION years have dreamed of ever telling this loved one the things I had thought and felt that I spilled out in therapy . . .

Mostly, though, after the first two hours of shock and a myriad of all sorts of feelings, I mostly felt PAIN. A deep and abiding pain that I had caused such (what I felt to be) DEEP pain to my loved one. As the evening wore on, this pain consumed me more and more until I quickly became incapable of functioning very well at all; in fact, I could not sleep at all that night, and at 8:30am the next morning, I asked for an urgent appointment that day with my psychologist, if he could fit me in.

He did, indeed, fit me in; and later reassured me when I enquired (inquired?) that this was an appropriate request for me to have made, given the situation and my level of distress (well, not in so many words but that's basically what he meant).

After the appointment, having gained a bit of perspective, and a little bit of distance from my pain, I was able to function a bit again, but I was still filled with pain.

I still am, close to a week later, although the feelings, especially those of an anxious nature, were mitigated and reduced by the miraculous to me fact of his eventual forgiveness of me, last week.

I am doing my best to process this and move past it, but it still has a bigger hold than I'd like. I also realize that some time may be part of the necessary healing element, here. Writing will be helpful as well.

Also helpful was the fact that my psychologist was unhappily surprised by the fact that people could hear some or all of sessions (I speak louder than many in day to day life; on the overheard session in question, I had so much to say I was unaware that I was speaking even louder than normal, but apparently not loud enough to elicit any cautions from my therapist . . . . ). See, I have heard bits & pieces of others' sessions since he moved to the bigger office down the hall a few years ago; my loved one has had the same experience of my sessions, hearing bits and pieces.

My therapist is going to put some kind of noise generator, a white noise, ambient noise thing, in the waiting area, after consulting and getting agreement from the lawyers who share that waiting area with him. This made me feel safer, although I won't feel entirely safe again there until it's done, and even then, the fear I feel inside, because I REALLY opened up COMPLETELY and showed the UGLINESS inside that I've always feared would lead to really bad things if people saw it or heard it, well, I don't know when I'll get over that fear, which is obviously fodder for therapy.

Anyway. Just because this person forgave me, doesn't mean they aren't still hurting, but it does mean they've gotten to a better place with it than I have. For my part, I forgave them for not moving to a further location when they realized they were overhearing my private session. Still, I have a whole host of other issues to deal with, and the biggest one may be how to forgive myself. That's something I'm not very good it. Yep, more fodder for therapy.

Double-Booked Psychotherapy Appointments: When It Happens To You

You feel unpleasantly surprised, when you arrive and see the waiting area (in my therapist's case, there's only seating for two) occupied, with a mother and teen son.

You feel brought up short, yanked backwards, because in the car on the way to your appointment, you've been shuffling through a whole host of important things currently going on with you, trying to prioritize, trying to decide what to talk about, and then BAM, the rug is yanked from under you.

Before the therapist's door opens to see the situation (he's running a few minutes late with his 4pm appointment, it's now after five) you start discussing the situation out loud with your husband, knowing the other patients will hear you. You say things like, "I could have sworn he said we were switching to Mondays," and other things that indicate you have a right to be there, too, as you feel as if you have to justify yourself (which you don't, at least not to the other patients, but my anxieties tend to run amok . . . .)

When his door does open, he greets the other patients and then steps out far enough where he can finally see you, and a look of being unpleasantly surprised crosses his face. There's no getting around it, seeing your psychotherapist seem to feel unpleasantly surprised by YOUR presence, by YOU, is slightly jarring to the therapeutic relationship; pushing forward through THAT awkward feeling, you realize that of course this is awkward for anyone (although throughout it all, the other patient(s) never said a word and acted as though the appointment was theirs all along).

So, you step forward to greet your therapist as he gets over his initial surprise quite quickly, flashing through some confusion as he queries you about what you are doing there . . . and you realize inside, feel, that "Oh no, I am really stupid; what and how did I get this wrong?" On the other hand, you DID bring your spouse up to his floor with you, which you usually don't do; this was done in case I remembered our schedule change incorrectly, although I had been pretty sure I'd remembered it right. I pretty much always bring my spouse up when there's been a schedule change, because of anxieties about getting it wrong.

So I explained what I was doing there, and what I thought he'd said during our discussion in December about how our schedule was going to change, and he told me, "Yes, but," and told me some other things he thought he had added that I didn't remember. Quite quickly he started apologizing since there'd obviously been a misunderstanding (it felt, to me, at the time, right there, that perhaps he was apologizing just to speed things up to get to the other people, and not because he actually thought he might have messed up), and I started apologizing as well; things before he went on vacation at the end of December WERE kind of hectic and who knows, maybe I remembered it wrong.

So, after that wrapped up, about 90 seconds total, I and my spouse left, and I said that I felt like an idiot.

Still, I got over it. One does, you know. Everyone makes mistakes, and misunderstandings happen. Whether it was his mistake or my mistake isn't very important to me, anymore, I realized after I got home. I had more time to think on it and really felt more badly for the awkwardness the situation had caused him, than for my being put out at all by it.

Still, it was VERY nice of him to call me a bit after his 5pm appointment was over; he apologized in a way that felt more thoughtful, less rushed to me, but then he'd had some time to think about it since it had happened. He said that he did feel that he'd contributed to the misunderstanding, and he was sorry that he'd had a part in creating such an awkward situation (well this isn't exactly how he put it but it's what I can remember of what it seemed he was trying to get across). I accepted his apology and gave my own; after some time at home (it took an hour lol) some of the things he'd said that he'd thought he added started to sound a little vaguely familiar. So I did indeed feel like I'd either not heard him due to distraction at our last appointment, or that I'd remembered what he said wrong; for his part, based on our conversation before his 5pm appointment started, it seemed like he had remembered our discussion a little incorrectly as well.

Regardless of who remembered and forgot what, the fact that he called me really made me feel better about the slight unpleasant feeling I'd had when he was looking at ME as though I were the cause of something unpleasant; it was really nice of him to call, and I think especially nice, as a professional courtesy, to do it.

Don't Sweat the Small Stuff

After 40 minutes of walking around Wal-Mart, with half or more of that time spent looking at things in aisles without walking much, this is how I looked as soon as I came home.

Sweat was raining off of me if I tilted forward a little. But only my head and neck were sweating.

 

This has been the case ever since I started Effexor some years ago, and it hasn't stopped though the Effexor was halted in February of '09. Recently I read that excessive sweating can be a symptom of serotonin syndrome, but there's other symptoms as well; I don't think I have that because of one symptom. I did take Cymbalta throughout much of the rest of '09; then, in '10, I was tried on a few different antidepressants but none after the summer.

This symptom or whatever it is, is extremely embarrassing to me, and highly inconvenient; it's already hard enough for me to go to the store and walk around, with my knees/legs hurting, and often a limp, so my motivation to go out is already low, but this sweating causes me to not want to go out anywhere if much walking is needed.

I suppose I could wear one of those around the neck fans, into the store; we've got one, although it eats batteries . . . but I'm afraid people will think I'm wierd, especially if I do it in the winter. My therapist says, "Nobody's looking at you, they're not thinking about you." I think he may be right, partially, but the fan makes a noticeable though not loud noise, enough to catch someone's attention, so . . . and even with the fan, I sweat too much, but it helps slow the rain a little.

For years, I've thought of this as a small, permanent side effect of that medication. Now, I'm thinking maybe it's not so small, since it's interfering with my life. Granted, part of what's interfering with my life is my anxiety about this side effect . . .

I remember way back when, mentioning this side effect to my first psychiatrist; the thing is, this may have been while he was temporarily suspended, and so the substitute heard it. He may have gone over her notes before seeing me again but maybe it didn't jump out, if she wrote it down. I might have brought it up with him later but I really can't remember. Nothing much was made of it if I did, and I wish, if I did bring it up with him, that he had asked me more about it.

Maybe I feel that if he had he could have done something to make it go away, but if it's permanent now then maybe it was permanent as soon as the side effect first showed up . . . but that doesn't mean the psychiatrist shouldn't care about it, right? I'm just feeling really let down by those who one trusts to take the best medical care of them . . . it's just that this is a pretty big thing, for someone who tends to have hermit tendencies, this kind of clinches it . . . and that fills me with sorrow, though I don't know why.

So, for a long time, I didn't "sweat" what I thought was a small thing. Now, I no longer think it's a small thing. Maybe I'd be better off if I didn't care, because that would be one less thing to be depressed about; ie, being depressed about something you can't change probably isn't the best thing in the world.

Reassessing the Roles My Therapist Plays

I know I sort of recently said I'd get around to discussing the roles my therapist plays, at least that I think he does, but a week and a half ago I had a session during which a thing or two he did as well as didn't do, really bothered me, to the point that I woke up in the middle of the night that night and couldn't get back to sleep for hours due to thinking about it, trying to work through it, and trying to figure some things out.

It became clear to me when I woke up later after having fallen back asleep, that maybe I needed to reassess some of my attitudes towards therapy, some of the roles I think he plays or want him to play, and reassess my general orientation towards therapy. I kind of need a paradigm shift, about what I expect and want from therapy, and what I want it to do for me, and whether or not I've been expecting THERAPY to do for me what I should be doing for myself.

At the same time my thoughts get so distorted and tangled sometimes I KNOW I can't always sort them out myself; in fact fairly often I cannot and get stuck. But is helping me see the distortions in my thoughts, and helping me to work inside myself to come up with alternatives to those distortions, ALL my psychologist is there for?

Often, he also reveals observations about my behavior, sometimes connecting things from months or more ago to something I just brought up, and it's sometimes a "lightbulb" moment when he does this. Other times it feels like he is observing, without connecting with what I'm feeling or thinking, when he does this. And so I then feel like he is being, well, cold, almost, or so neutral that it feels like I'm not interacting with a person; like WE aren't interacting at all, but rather that he's just stating his observations without other therapeutic things going on, like empathy and such.

I suppose the nature of observing, and being observed, is that the observer, in order to adequately identify and point out what they are observing, has to hold themselves apart, in some ways, to keep anything emotional or biased from affecting the observation. I think it is that "apartness" that I sense when he's giving me observations that bothers me, a little bit.

He does, though, give empathy when he determines I need it; he gives understanding, he gives patience, and even kindness from time to time. He gives objectiveness (which sometimes promotes that sense of "apartness" in me) and he gives no judgements (most of the time; he's not perfect and when I think he's judged me, I say so and he'll most often explore it with me for a minute and, if he thinks that he did, indeed, judge me, he apologizes for it).

I should say that he strives for objectiveness and lack of judgement; these seem to me to be two of the hardest things to accomplish, especially after you've been working with someone for years and could have some caring about their welfare. He has said, on a couple of occasions, when questioned about it, that he DOES care about his patients; he has said that is an acceptable thing in his work, and a natural thing to happen. It's my opinion that the better therapists (I've only had one, though, so it's a guess) DO care about their patients, on a basic human level. I'd imagine that those who don't would come across as cold all the time.

Even knowing this, I still have times I struggle with feeling less "connected" in our therapeutic relationship. Is connectedness, a feeling of give and take, a feeling of working TOGETHER in therapy, necessary, positive, etc. for the therapeutic relationship? I would suggest that yes they are essential for a good working therapeutic relationship. This does not mean that the times I feel this "apartness" I've described indicate big problems in the therapeutic relationship; it just means that maybe I should note these things to him so he's aware that I feel these things when triggered by specific things during therapy. It does NOT mean that he'll necessarily change his behavior, but I believe it's important to communicate with your therapist if and when you feel like it is more difficult to connect with them, or any other things that trouble me about the relationship at any time.

This makes me wonder, am I after too idealized of a therapeutic relationship? I am thinking right now that I know I tend to idealize people who treat me positively, and so I wonder if this is another attitude about therapy that I need to examine and perhaps change. I do not know that I necessarily idealize the relationship for sure, but this blog post surely gives me THAT impression. I will think some more on it and even talk with my psychologist about it.

There have been occasions I've taken one of my blog posts into therapy, read it, and then discussed it with him, sometimes point by point, and sometimes at the end of the thing. I think this one would be good to bring to therapy this week.

I don't know why it still surprises me after all this years that writing or typing out my thoughts and feelings on a subject will sometimes lead me to new discoveries, unexpected realizations, and even a reassessment of my own behavior or thinking/attitudes on a subject.

A postscript on the Lamictal rash: Well, welts never showed up and it became even more sandpapery feeling, so I was right that it was not the "bad" one that leads to Stevens' Johnson syndrome; on the other hand, I've had it for a week now and taking Benadryl changes it only a little, though I admit most days I've taken it sporadically.

What I do not know is if I should bump up my dose to 250 mg tomorrow as scheduled; the rash appeared the morning after I bumped it to 200; I may be too fearful and cautious, but I will keep it at 200 until I hear back from my psychiatrist via email; I don't think it's urgent enough for a phone call, and it shouldn't hurt me to stay at 200 for a bit longer (I hope!). I guess I fear worse allergic reactions like anaphylactic shock if I bump it up higher, with the rash not responding much to Benadryl.