my complicated T situation & ?

My complicated T situation (in place for about a year now) is facing a challenge.

My secondary T--local, the main one is remote (we work by phone) in NYC--is moving away in May for her residency. I face the question: Replace her or not? It seems unlikely that another T will want to take "second chair" to another T (though somehow it's worked out well). Adding to this is that I can't afford to keep working with my NYC T without Medicare paying--it isn't right now. I've paid cash for 14 months now. On top of all this, aside from a pdoc, I have a group I’m in with a PhD T who’s available for individual sessions as needed/wanted.

So need to figure out whether to go just with NYC T on phone or go with one local person—I’m assuming no one will want to be a 2nd therapist while I’m working with another one. I was in unique circumstances a year ago when I started with the 2nd. Hadn’t had a T at all for 4 years, got very sui, sought out my old T from NYC for interim help.

I’m feeling: like I’ve retreated the past 4 months while dealing with getting re-evaluated by SSDI—I held back from taking some steps forward to not hurt my chances. I’ve also felt a distance with my NYC T for a few months.

Speak to NYC T tonight in a few hours. Haven’t brought up the issue with him yet. See local T tomorrow, last week was when we first spoke of her leaving.

Very anxious. Feel like I can maybe progress greatly with him personally unlike with another T, but it’s all mixed up re: distance, money, proximity, lack of being “seen” in literal sense, etc.

Not sure how to get into the whole issue with him.

Wow! That is complicated.

I don't have any advice for you, but am interested in hearing what others say, because I'll be in a situation soon where I may have two Ts...I'm moving and my current T has offered phone sessions for a while, but I'm supposed to find a local T as well.

You say that you've felt some distance from NYC T for a few months now, but later you say you could make progress with him? Am I reading that right? Seems like a contradiction...

Regardless, I'm sorry you're losing your local T. That must be hard...

Yeah, that is really complicated! I'm sorry you're losing local-T. It looks like even if you wanted to keep doing sessions by phone with NYC T, that you would still not really be able to afford it. How do you feel about the T leading your group? Any good? Accepts Medicare? If not this one, are there good T options in the area? Can you shop around? I know having a good T makes it seem like no one else could fit the bill, but perhaps you might find someone closer by who can help you progress. Maybe you could ask NYC T to give a new T a rundown of what's going on with you so you don't have to reinvent the wheel. I think it is kind of nice that you can have the support of NYC T through the process of finding a new T when your current T leaves. I think a T would understand tapering off phone sessions to do a proper transition, but I agree that most T's don't like a person seeing two T's for individual therapy at once (usually because they may have conflicting opinions), and a T especially doesn't like to work outside of the kind of therapy in which they feel professionally competent. You know?

I say, just broach the topic with NYC T by talking about how your local T said she was leaving. Just in the "how was your week" conversation, I think this info fits in nicely to that. How was your week? Yeah, not bad, but local T told me she's leaving in May. You know? Let us know what you decide to do!!

hoping it works out! hate it when things get complicated re T (mine is too... *sigh*).

impy, i'm tired - so to be brief:

- decide first whether you can/can't afford to pay for NYC-T and whether this "distance" you speak of is a deal breaker or not. this will dictate whether you are in fact looking for a second chair T or not.
- re: "second chair" therapist. you're making assumptions re: what therapists are willing/not willing to do. why not make a few calls and see if this is actually the case? old-t and austin-t have both been happy to play second chair to pdoc, knowing full well i do a significant amount of therapy with him.
- what is the go with group phd T? is this person someone you would entertain as a possible individual therapist?

um. possibly rendundant reply - have you spoken to NY T yet? hope it goes/went well, let us know.

juggling Ts is hard. austin/pdoc work because i have separate issues for them, conceive of our relationships differently. but if it was the same ground i think i would be confused. how is the current set up working for you?

imapatient, I work with (or have worked with) multiple Ts in the same way deli describes. They each have their own role and we talk about different things, work on different issues. So it might not be that hard to find a "second chair" T if this T would be working on different stuff from the phone T. I guess you never know until you ask. I am sorry your local T is moving away. I hope that ending is not too difficult for you. Maybe she would have good advice. She could tell you how she has felt being the "second chair" and what made it work for her and what made it difficult. What was your reason for wanting the secondary T you have now? Was it so you could have a local person for face to face (more helpful to have in person support)? If that is really important to you, and you want to drop your T body count, maybe working towards discontinuing with phone T is the road to take. But discuss with all your Ts for their opinions and insight. Good luck.

Quote:

Originally Posted by deliquesce impy, i'm tired - so to be brief:

Thanks Deli for putting in black and white the basic steps.

Lots has happened. This is going to ramble as I’ve composed it in three different chunks and then delayed posting because it is just, well, rambling.

Talked to NYC T about it; went well.

Talked in group about it--good. One person pointed out that I was worried about making the final decision rather than focusing on the specific steps right in front of me--I was letting the big picture anxiety interfere with the immediate steps.

My group T gave me the name of someone. Group T is a supervising psychologist for a major health system here, so he oversees tons of T's spread throughout the state. He had hired the guy in question.

I've started looking through various locator services on-line--Psychology Today has one.

A major problem I run into is that there are relatively few male T's (looking for a male on multiple T advice; long story). It's at least 5 females to 1 male ratio.

I've gotten some advice at variance: Local T thinks I need to work with someone who's very behavioral oriented, NYC T thinks I need that plus some strong analytic approach--psychodynamic.

The one my group T suggested is primarily behavioral but also psychodynamic. He said he also specializes in csa, something that's been recommended (as for getting in a program for), but hard to come by so far.

Wow. It's difficult. You only get to learn so little about these T's on-line. I'm surprised at the low number of PhD T's out there, my preference for various debatable, personal reasons--spawned by suggestions from some T's, but maybe it’s outdated advice now). I haven't really looked for a T in more than 20 years and it's a different world now. A lot of T's have degrees from places that weren't producing many therapists back in the day; a wide swath of the MA-level (who constitute the vast majority of those available on the search sites) are from 2 programs that were minor-league way back, and most PsyD's are from a school that barely existed back then. Even though it's a big metro area, people with doctorates from standard full universities are quite rare. Unless they're less likely to sign up for these services. Where do they practice, or are there fewer of them these days? The local T, who’s a PhD student at the big university here, has few connections in the practitioner community—because she’s an academic (top 5 school) and the profs are fairly clueless about practitioners; only 1 of them is licensed to work with people, so she's of little personal help in coming up with names. Am hoping to get more names from group T, but just the one so far and I think he might tend to refer within his same company.

Lots of stress over this. At base are 2 fears: 1. Being back where I was 14 months ago before I got hooked up with NYC T again (after 9 years, 4 of those with no T at all) and started day treatment etc. Very, very bad, dark, scary places. 2. Fear of ending up with a bad (unethical—in a grandiose way) T (like before) and wasting years of my life with him. The stress of sorting out so many variables and my fears made me snap in an outburst, a kind of out-of-body experience that has me freaked out. I’m really on edge. I don’t know why I feel so fragile, but I feel like some other important contacts and relationships are slipping away, too.

Have had weird sleep/wake thing going on. Newly on Klonopin in past 6 weeks “as needed.” I’ll take it—but only half .25—and then it knocks me out for 2 days. Then I have insomnia for a few days. When I get so anxious again I’ll take it again and the cycle repeats. Don’t feel like I’ve had a normal night of sleep in a month. Obviously something going on there, but won’t see pdoc for another 2+ weeks (he's impossible to get into see outside of the regualr meeting). Klonopin helps calm me down when I get super-anxious and the ruminating starts getting pretty bad, but the sleep/insomnia thing is a killer, and maybe it’s weakened me overall hence my extra worries and snapping. There are so many variables involved in a person’s life at once; how do you know what is what? Hence, what to do? Maybe I need the Klonopin b/c the anxiety is so overwhelming that it’s helping, or not.

Next up: Talk to NYC T Sun at 6 pm. See local T on Tues. Group on Wed. Talk to one friend about the stress and my snapping on Wed, another at some point, though we did right when it happened a little bit.

I do have an appt. with theT that my Group T suggested, but it’s not until mid-April. He has a PsyD from a full-on, regular university, not a professional school of psychology. Thought PsyD's were usually from the latter kind of schools. Ah well. Can't find much about him on the internet. With going the PhD full-university route usually there's a longer paper trail, e.g. a dissertation, etc. But he's a blank slate mostly. That's probably better for a first meeting.

I'm really wound up right now. Apologies for the scatteredness of my thoughts.

i like the scatteredness - real impy coming out. i wonder if you would have censored more if you were less tired (i ramble most about myself when i should be in bed).

too tired for full on reply now (and i have a lot to say, lucky you) but thought re: the phd thing - most phds (in australia anyway) stay in academia, because you still need a masters to be a clinical psych. i.e., even if you have a phd, you still need the masters. so there's no reason to get a phd these days, especially when it's so ridiculously competetive and you dont gain much practical experience from it.

old-t was a phd - possibly the most intelligent guy i know - and also a royal prick. stayed with him for 2 years because i had faith in his intelligence. only hurt me in the end.

austin-t quit his phd last year. no way near as smart as old-t, but he's psychodynamic and he speaks to me on a different level. somehow manages to bypass a lot of my analytic thinking and just... i dont know. gets me doing stuff.

he has a strong behavioural approach and he gets trauma. he teaches me a lot about psych theory but he rarely argues things out with me (in a way i'm accustomed to - analytic arguments). i am free to tell him his theories are ******** however and he wont try those out with me again (he now knows i have no patience for DBT ).

ill come back tomorrow. just want to send some love your way .

Imapatient,
Sounds like such a difficult time of changes and transitions - would be hard for anyone.
I understand a lot of your anxiety about finding a new T.
I'm to the point where I actually refuse to start over with a new T and just went back to my current T to try to work things out. Your fear of ending up with an unethical T is very understandable. I think you awareness of the possibility will help protect you, although it may make a new beginning kind of slow until you are able to trust.

I'm sure it is hard to keep functioning when dealing with an unknown future, but you are doing it. I hope you can try to be patient with yourself, and take good care of yourself. It will take some time but things will work out, and I am confident in the possibility that this could lead you to someone who will be able to help you get to the next stage of your healing process.

Why dont you see if your favorite T can recommend someone for you. They tend to be friends and sometimes hang out together. If she likes him/her, chances are you will too.

Re: the PhD thing. In the US, deli, PhD programs have a Masters built in to the programs. Also, you can't be called a psychologist without a PhD or PsyD. With a Masters you are licensed as a mental health counselor or social worker and have some restrictions on your license that a psychologist doesn't have. As for where they are, lots of PhDs work in a variety of settings doing consultation, research, teaching, legal work, etc (in the US). A PhD provides experience in a range of these kinds of activities, so a PhD psychologist has a lot of flexibility and may not exclusively practice therapy. Many who practice don't advertise because they are already connected enough to get referrals. Then, as deli said, many choose not to work with people and stick with academia. Having a PhD doesn't mean you work well with people. The PhDs I know work in a clinical research setting; that is, they do research on therapy while they are treating people. Everyone in the clinic is being studied while they are getting better. This is something you will find at a University, and typically exclusively PhDs work in these settings. Just a little info..

impy.

re: base fears:-
1. i understand this fear. was it nyc t who pulled you through? if so, you can always fall back on him again, right?
2. i have faith in you that you have learnt somewhat more how to spot unethical behaviour. there is no safety net to keep you from falling in with a bad T, but maybe you know now what the signs are and can extricate yourself quicker?
i.e., re: both fears - i don't believe the past is going to repeat itself, as you now have more skills to deal with both.

re: klonopin. is it actually making you sleep 2 days through? am i misinterpreting? if so, you know you shouldn't be taking it right? maybe you need something for the anxiety, but i'm wondering if you could look at a different drug.

sorry this isnt a great post. im writing because i care, not because i have anything useful to say. and i dont know if the caring is coming across, but it's there because im here and writing it.

one step at a time, impy .

imp, i'm also concerned about what you said about the klonopin. i think it would be important for you to talk to your pdoc right away about the effects. also, maybe try taking 1/4 or even 1/8 of a pill so you don't sleep so long. i think i've heard others here say it's an addictive drug so please be really careful.

Thanks all.

No real news. Talked to NYC last night and told him about the guy I made an appointment with. He thought it sounded promising.

He had taken a look at psych today for my area when we were on the phone the prior session, and saw a guy that he thought sounded really good for me. I had saved a copy of that T's homepage in a folder I created for "potential T's" so it was reinforcing to have him bring the guy up. He really like the fact that this guy did "relational" therapy—or is theoretically inclined that way (?); a discussion of theories ensued. The guy would be in his 60s, PhD, has a long, impressive resume of treatment background, supervising, founding programs, professional service..... But who knows?

Thought I was meeting with my local T today (Tuesday), but no, not until next week. I’ll email her back and see if she has any names, etc. Wonder if I should ask about the “relational” guy? Probably won’t think it’s a good idea since he’s not a behaviorist.

Klonopin. I hate dealing with my pdoc. Appointments 2 months apart, horrible clinic to work with. He gave me a 6 week break between appointments this time, but then 2 weeks later they left a message to cancel. In my duress with SSDI eval, I didn't get back to the clinic for about 9 days. So my appt. is 2 weeks away still (that makes 10 weeks between appts. for what was to be a 6 week duration.) If it weren't such a hassle getting in touch with the clinic--nurse on duty 2-3 days a week--I'd try and let him know. I see now that it's a big deal for me because I have been experiencing extreme anxiety since our last appt--when the Klonopin was prescribed. But I’ll call and see if she’s in, and won’t take any more of it.