Struggling to Keep My Cool

Therapy was awful yesterday. I so infrequently identify my feelings as “anger,” but I definitely felt my blood boiling at the session.

We were discussing my decision to stop sessions and what I thought that would look like practically. I found myself immediately needing to become defensive and support my “argument” because my therapist was aggressively trying to dissuade me from doing that. Since it wasn’t news, as I had brought it up with a confident tone of finality last week, I expected her to be more supportive, or at least open-minded about my plans. This was not the case. It’s not even that it felt like I came up upon a brick wall; instead, it was like dodging ammunition from a firing squad on the offensive. Although this was much more confrontational and argumentative than I’m comfortable with, her adamant intention to squelch my desires and self-directed therapy goals was not even the most frustrating part of the session.

Let me start from the beginning: When I went through the intake process at the mental health center where I’ve been attending therapy, I had to meet with a designated intake counselor for two hour-long sessions. We discussed my mental health history, my reason for seeking psychotherapy, and spent a lot of time evaluating my interest in adjunct medicines. This detailed process is designed to match patients with an ideal provider who is experienced in the areas that he or she wants to address. Additionally, if medications are necessary or if the patient would like to consider them, the intake counselor assigns them to a psychiatrist or other provider certified to prescribe pharmacological agents. After the intake sessions are completed, the patient has to wait to be matched with an available therapist. For me, this took a little over a month, though as mentioned previously, my first match was terribly incompatible with my needs and personality, so after a few sessions, I had to awkwardly request a new therapist and wait again. In order to be considered for the med clinic to see a psychiatrist, patients must attend at least three therapy appointments before their name will be added to the lengthy psychiatric wait list. At both my intake appointment and with my first and current therapist, I indicated a strong need to consult with a medication prescriber and asserted that I want my case to be submitted to the wait list. All three providers agreed with the importance of this aspect of my care and assured me that I would be seen as soon as possible by a prescriber.

Over the past couple of months that I’ve been going, I’ve inquired about my status on this wait list. I kept getting vague non-committal answers. At last week’s session, I implored my therapist to track down someone from the med clinic who could give a more explicit estimate. Yesterday, I got it.

First of all, apparently you have to continue your routine therapy sessions to be even considered for a medication evaluation, which means that taking a break from therapy to do my own thing precludes me from remaining on the list. Secondly, the average wait time is approximately one year, which I was never told. Thirdly, and perhaps most frustrating, if you have ever canceled an appointment, you are removed from the list. Again, I was never told this and I did cancel an appointment in January. Lastly, every patient on the list is priority ranked based on the estimated urgency of their need for medication.

All this is to say that while this process may have merit, I feel it played out unfairly, at least in my case. I was never told the wait would be so long. When I asked initially, I heard the response that “after the wait to get matched with a therapist and attending the required initial three sessions, a spot usually lined up.” Obviously, this isn’t true if the average wait is around one year and sessions must be at least every other week and the matching process takes “up to two months.” Using that accounting, it would be at most 3.5 months, not 12. Secondly, I didn’t know you get bumped off the list if you cancel a session for being sick. Lastly, the priority ranking seems somewhat arbitrarily assigned into three broad groups (1, 2, or 3 in decreasing priority). My case was designated a 3, or lowest priority, right off the bat despite my assertion that it felt urgent and her agreement with that assessment. Additionally, as we’ve continued to meet, I’ve continually stressed the importance of seeing a medication prescriber. Neither of these situations seemed to modify my “lowest priority” designation. Of course, I don’t know the nature or severity of need for other waiting patients to obtain the services of a medication prescriber, so perhaps I truly am less urgent than all the 2’s and 1’s (if that’s the case, boy do I feel badly for them because they must be in a really bad place).

Needless to say, all this amounts to the realization that discussing medications won’t be feasible in this center. I especially wanted to consult with a psychiatrist about possible sleep aids, a short-acting anti-anxiety medication for very acute panic attacks (like when getting blood drawn or getting a Pap smear), and to transfer a medication I take for ADHD to this local provider instead of maintaining under the care of my doctor in Connecticut (which necessitates asking my husband to take off a day from work each time we need to go down and be seen). Now, I’ve wasted all these months awaiting an evaluation that will never materialize. I could have booked an appointment with an alternative local psychiatric provider and already made it through the likely long wait. Instead, I’m seven months in and nowhere.

The fruitlessness of this path was particularly infuriating to me because I felt like I was not fully or honestly informed about the process or somehow, I failed to understand at several junctures. Though it’s not uncommon for me to misunderstand things, the likelihood that I misunderstood every single time I asked and from three different providers seems unlikely, even for me. I think there was absolutely a degree of painting a more favorable picture of what typically happens coupled with an incomplete explanation of the requirements to be seen. For example, had I known that canceling even a single appointment is grounds for removal from the list, I would have immediately understood that this center wouldn’t be a feasible medication provider because given my chronic health issues, I can nearly guarantee that I’ll need to cancel at least one session in all those weeks. Secondly, the consequences of stopping therapy in my candidacy for a med appointment was not mentioned when I shared my desire to stop. That lacks the transparency that I think a patient deserves.

These facts, in aggregate, made the discussion yesterday about my location at the bottom of the list feel out of the blue and totally unfair. What further infuriates me was my therapist’s constant murmuring of “uh-huh” in a perky voice literally every third word like an invariable ticking clock as I tried to maintain my cool and explain my immense frustration about this situation. She would not stop! It’s no secret that I loathe repetitive noises, but this escalates to nearly intolerable irate feelings when it’s cheerily inserted unnecessary utterances interrupting every third word I voice. If nothing else, yesterday showed me that I can maintain a polite lid on my boiling blood and mounting anger.  I remained as respectful and composed as possible, despite nearly every neuron in my brain screaming to lose it on her and demand she stop “uh-huhing” so loud and so incessantly that I couldn’t hear my own words coming out.

Clearly, I’m still frustrated about it, but I exercised amazing self-control yesterday. In fact, I articulated my feelings about being unfairly penalized by this “policy” that I was not made aware of so well that my therapist advocated my case after I left so that I can be moved up on the list and considered in light of the strikes against my priority seeding. I really appreciate that she pursued this for me and it goes to show me that by rationalizing my point of view and sharing my feelings maturely instead of having the tantrum I wanted to, I ended up getting what I needed as an outcome instead of burning a bridge. Of course, I still don’t have an appointment with a psychiatrist and if I get one, I have to agree to continuing therapy at least once per month, but it’s a start. I’ll definitely research alternative providers in my area in the meantime, but my therapist re-garnered my respect for her follow-up decision to advocate for my needs based on the “case” I presented of being unfairly treated. All in all, the session, which felt like a forty-five-minute altercation took a lot of emotional energy. The rest of the day was spent trying to rebound and move forward.

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