Need advice: Should I stop therapy?

Gwen Cooper

Hi everyone,

I was diagnosed with BPD about a year and half ago. I'm going to a psychiatrist via HSE every 2-3 months. I have an appointment tomorrow and I'm thinking about telling them that I don't want another appointment, as I feel that it's doing more harm than good.

It's an outpatient clinic with a number of psychiatrists. I've had 6 or 7 appointments already, with a different doctor every time.

I started going there after the antidepressants prescribed by my GP weren't working as well as they were supposed to. My GP said that she can't prescribe anything else herself and referred me to this clinic.

I also attended Pieta House, but that was done and it was up to me to get help somewhere else.

On my first appointment (this was before my diagnosis), the doctor looked at me and asked me what's wrong. I described how I feel, I started with a smile but of course halfway through I broke down in tears, telling him about my issues. He started laughing and asked "but why are you crying?" We then started talking about my medication and I told him that it's not doing anything and that I've had new symptoms since I started taking it. I described that within two weeks of starting on the medicine I started feeling extremely paranoid, on numerous occasions I was convinced that somebody is following me (I even saw someone walking behind me from the corner of my eye, but when I turned around, of course there was nobody there), it also did something to my hearing - certain sounds, such as cutting the wood on a circular saw, would get translated in my head as people, mostly children, screaming in agony. The symptoms I had before were also getting worse and I explained all this to him in great detail. He looked at my file, looked at me, back at the file and then he said "Well, the medication should be working, so I'll leave you on it." He then asked me to go back to the waiting room so he can "go over my story one more time in peace". He called me back after a while and told me that I can go home and that they can't help me here. I had a meltdown as soon as I got home. I made a decision to stop taking the medication as it was making things worse.

I received a letter from the clinic a few weeks after, with an invite to another appointment.

When I attended this appointment, I was talking to a different doctor, who had two med students with him. He asked if I'm ok with them being there for my appointment and I had no problem with that.
I started telling him that I actually don't know why they called me back as the previous doctor told me that they can't help me. I told him that I stopped taking the medication and while he said that this should have been consulted with a medical professional, he was ok with it as I was managing well without it.
This doctor was very nice, really listened to what I had to say. He was the one who diagnosed me with BPD. I felt very relieved after having a diagnosis, I thought that after years of struggling, this can be the turn-around point and I can finally start getting help aimed at a specific target, not just some unidentified mental illness.

The next few appointments were pretty much the same: "hello, what's your issue? ok, and how is that going? great, stop by the reception when you're leaving and get another appointment in 6 to 8 weeks."

I got back on a different medication for a while when my depression & anxiety got worse.

The appointment before last, I was running late, nothing was working out for me, buses were late, roadworks in the city, bunch of people not having their change ready for a bus ticket and then paying 2.70 in as many coins as possible... it wasn't a good day. I got there about 10 minutes late, despite leaving work more than 2 hours ago and not stopping anywhere. The doctor was on the way out of the door, but he agreed to have a chat with me. As soon as the door to the room closed behind me, I fell on the floor crying, full-on panic attack, I described how I feel and that I'm suicidal. I kid you not, he looked at his watch, then back at me and said "Well, keep taking your medication and we'll see you in 2 months." The whole appointment took less than 10 minutes.

Of course I didn't want to be admitted to the hospital that day or being declared danger to myself, but looking back, I'm pretty angry that he didn't do anything. On that day I was ready to kill myself, I was planning it in my head because I've had enough of everything. I cooled off on the way home, but he had no way of knowing that that will happen.

The last appointment, 3 months ago, was pretty much uneventful, the doctor was nice enough, but I've been waiting for ages to see him, I was tired and in a non-cooperative mood. I told him that I want to stop these appointments, he told me to think about it until next time, which is tomorrow.

I work on the other side of the city, but I have to attend this clinic because it's close to where I live. I asked them if I can go to another clinic, close to where I work, and was told that HSE wouldn't allow it.

I always need to find someone to cover for my shift, I'm always stressed about being late to the appointment, I haven't had a session with the same doctor twice. I always super stressed out about the next appointment and who will I have to talk to next.

In my opinion when it comes to mental health, I should see the same doctor every time. The doctor would then "know" me and notice any changes in my behaviour.

The sessions are not doing anything for me, they are just causing me stress. I'm worried that if I opt out, I will have nowhere to go.

If anyone asked me if they should stop their therapy, I would say definitely no. but here I really don't know, I'm conflicted.

Any opinions would be appreciated.

Thanks.

ds4593

I feel for you. I now what it is like to be hanging by a thread, crying out for help, only to have no one take you seriously.
It is enough to push a fragile person over the edge.

As for if you should keep going to therapy?
I would say of course, stick out the therapy. But it really sounds like you aren’t actually getting therapy.
Going in and telling a new doctor your base story every time isn’t therapy.
Where is the progress? Is there any talk about a plan or type of therapy like behavioral or cognitive therapy?
You should at least go in and ask these questions. Even ask if it is possible to see the same doctor each time.

You obvious need and want help. So asking some of these questions in the next session will at least give you an idea if you should continue. You can even ask them for advice regarding receiving help from other avenues.

Gwen Cooper

ds4593 wrote: »

Going in and telling a new doctor your base story every time isn’t therapy.
Where is the progress? Is there any talk about a plan or type of therapy like behavioral or cognitive therapy?

Hi there,

Thanks for taking the time to respond

I forgot to mention this in my original post - I was offered to be put on a waiting list for something called U&ME (Understanding & Managing Emotions). It's meant to be really helpful for people with BPD.

I had to refuse this as it's spread over 6 months and it would mean that I would miss one full day of work every week for 24 weeks.
I can't afford losing €350 a month for missing work, and it would be hard to find cover for me for a day every week. I am the only person in my department and my job requires me being on the work computer 9-5, Monday to Friday.

It's hard enough already to find a cover just for a half day every 8 weeks when going for the appointment, as they have to pull someone from other departments, find a cover for them in their own departments, etc.

I know that I'm complicating it for myself by refusing this, but it's simply not an option.

I am going to ask them if it's possible seeing just one doctor, but I'm not optimistic. From what I've seen, once you come in for your appointment, the receptionist puts your file on a pile and as soon as one doctor finishes with a patient, they just grab the file on top and call this patient in.

We'll see. I'll post tomorrow to say how it went.

Would you be able to afford fortnightly private therapy Gwen? That would work out at maybe €100 a month.

Gwen Cooper

Deleted User wrote: »

Would you be able to afford fortnightly private therapy Gwen? That would work out at maybe €100 a month.

Hi,

thanks for your response

I am considering it. Probably can't do fortnightly, but maybe I could manage once a month. There's a clinic nearby and they are open 7 days a week, so I emailed them to see if they have any experience with BPD. They're expensive though.

I don't even know who would I need to talk to - psychiatrist, psychologist, therapist? Internet seems to have different opinions. I'll ask the psychiatrist today who would be my best shot.

wexie

Hi again Gwen

Right....first things first...you haven't actually started therapy so in that sense there's no worries about stopping it.

Seeing a different registrar every 6 months (they change every 6 months so there's nothing that can be done there) isn't helpful by any stretch of the imagination, I know how all of that works and all I can say it's less than helpful.

Psychiatrists tend to be very medication focused, they deal with psychiatric disorders ie. things actually not working as they should in the brain, like bipolar for example. These are generally things that can be managed with medication.
But you know the old saying : if all you've got is a hammer then every problem looks like a nail....

BPD is, the name implies, a personality disorder. It's not anything wrong with the brain but just a collection of unhelpful coping mechanisms learnt over a long time (really very simply put). Now the good news is that personalities over fluid, they can and do change over time. My psychiatrist explained it using temporal validity, ie. somehow who is bipolar now will be bipolar 10 years from now, it can only be managed. Someone who currently presents with a diagnosis of BPD may no longer present with that same diagnosis 10 years from now.

Unfortunately though that takes work, it takes therapy and it takes practice. None of which you are getting from your monthly with so many psychiatrists. Ideally what you need is a clinical psychologist but from what I understand these are in extremely short supply in the public health service.

If I were you I would push (and push hard) for a referral to a psychologist (they may not have one, my local team didn't have one for 2 years and when they got one they flatout refused to even refer me :mad:).

And if you can't go that way perhaps see if you can find one privately.

If you have private health insurance....(you probably wont like this option much) it may be an option to get into a (private!!!) psychiatric hospital for a while. They will be able to do a full and thorough assessment and more importantly they will be able to refer to you courses that the insurance will cover. (it's absolutely insane that insurance won't cover seeing a psychologist but they will cover going into hospital (mine was 550 a day) and the courses afterwards. Or they'll cover acupuncture :mad: )

Just as a comparison, when I was in hospital I saw the psychiatrist (one of the leading ones in the country) twice a week for (literally) as long as was necessary....

Lastly just to point out : I am not a health professional in any way, this is all from my experience and second hand knowledge from the various professionals I've dealt with.

Best of luck and congrats on the new job

EDIT :

And I know I mentioned it half flippant but don't immediately discount the hospital option if you have insurance.
(I would NOT recommend a public psychiatric hospital, I was in one and it was about what you'd imagine from seeing them in the movies )

Gwen Cooper

wexie wrote: »

BPD is, the name implies, a personality disorder. It's not anything wrong with the brain but just a collection of unhelpful coping mechanisms learnt over a long time (really very simply put). Now the good news is that personalities over fluid, they can and do change over time. My psychiatrist explained it using temporal validity, ie. somehow who is bipolar now will be bipolar 10 years from now, it can only be managed. Someone who currently presents with a diagnosis of BPD may no longer present with that same diagnosis 10 years from now.

Hi Wexie

I never thought of BPD this way. It was explained to me that my brain is just wired differently. Your explanation, while I understand that it's a little bit more complicated than that, gives me a new perspective. Thank you for that

I put together a list of things to say to the psychiatrist today (I'm pretty sure that when he/she sees it, they will curse the moment they picked up my file from the top of the pile ). It's made out of two parts, first it's about how my symptoms got much worse over the last month or so, how I feel and what they are exactly. For some reason I'm not able to think about these things when I'm sat there and they ask me what's wrong, so I hope that the list will help me, and eventually help them help me.

The second part is a few questions about what can be done. I'm going to ask about mood stabilizers, I read a lot about them and it might be beneficial in my case, even when the doctor would have the final say in it of course.

I'm not Irish and I have a travel insurance from my home country, with unlimited cover for urgent issues. I'm not sure if they would cover this as they might not consider it urgent enough. I wouldn't want to get them involved unless necessary, as a few years ago doctors suspected I might have a brain tumour due to severe headaches, twitching limbs, loss of balance and the ever-worsening mood swings, I was going back and forth from the doctors, after the insurance covered an MRI scan for €200, they contacted me to tell me that I can either go back to my home country (they would cover my flights and other relocation costs) until I get better, or that they will stop covering me. Since then I only contact them to cover me for little things, like GP visits and antibiotics, just to make sure that I will be covered if some s**t hits the fan

Really appreciate your suggestions Wexie, I added a few bullet points to my list for today based on your post

wexie

Hope you got on okay Gwen