Trust

I have been seeing a T for about a year. The reasons for going were low thoughts, which I thought were due to entirely situational factors (recent and past). Although I think I have benefited from the T, I am frustrated that I still have many annoying symptoms plus I still get very down and SI.

I have been reading loads of stuff and had reason to look up bipolar II on the internet - I cold relate to many of the symptoms - well 99% of them actually and e-mailed my T as it had scared me a little. Of course I understand that he is not able to diagnose, however he didn't dismiss it. He later e-mailed me again and asked what I thought I might gain from a formal diagnosis.

Just now I have been sitting thinking and I recall describing a social event to him when I highlighted that I suddenly felt very confident and chatty and a firiend had asked what I had jsut taken (I hadn't taken anything). I remember my T dwelled on this for a while before me moved on to talk about something else.

I am now wondering whether he has thought all along that I may be suffering from this diagnosis and I am now feeling really let down and patronised. I know I could talk to hiim about this, but I am not sure whether I trust him to give me an honest answer. Not sure what I am expecting from posting this, but writing it down has at least organised it all for me and stopped it going round in my head.

I know what it is like to feel like your T might be keeping things from you.

Do you feel that you are being adequately treated? I just wonder why you are looking up diagnoses on the internet.

I'm not sure really. I just would have hoped to be feeling better after a year - progress has been slow as I find it really hard to trust anyway. I have never sought any treatment before or even spoken to anyone about my symptoms, so have never had a diagnosis / explanation for my problems.

My T is reluctant to talk about diagnosis as he feels it is the symptoms that are the most relevant thing to work on - however I really want to understand myself more and am rather stuck on getting a label of some sort.

Hey,

some therapists don't really like labels, they see it as a way of avoiding what might be really causing the behaviour and instead of looking for reasons why you behave a certain way, you may just say "it's my bi-polar."

As you said, Therapists don't diagnose, only a psychiatrist can say that you have bi-polar or not. others may be able to suggest or ask you if you feel you have it but that's about it. You are only describing one incident that may suggest a manic episode, but it could also suggest just a boost in confidence or feeling good about being where you are at the time, a diagnosis of any sort couldn't be made from this.

If your therapist was to say " i think you have bi-polar" and then you went to a psychiatrist who said " no you dont" you may end up feeling mad that your therapist told you that you did!

As you said your T is not dismissing the possibility but perhap he hasnt seen any other behaviours that warrant him to think you have bi-polar anyway and that he's not hidding anything from you? You are presuming he is.

When he asked what you would get from a formal diagnosis, I think what he means is, if someone told you tomorrow that you had bi-polar, would it change how you feel, how you act and behave etc? No it wouldn't,you would be the same person you are today only with a label.
I understand how having a diagnosis can at least shed some understanding on the subject but if you really want to be assessed for it then you need to go and see a psyhiatrist.

I think T's sometimes may think that too much information might worry us or scare us. But, for me, I NEED to understand. I NEED information. I supplement my sessions with a ton of reading.

Now, that may not work for everyone but I'd say that if it is important to you, don't let your T sidestep the question.

With a diagnosis, you would be able to understand your behaviors better and would be able to reach out to others with a similar condition.

If it were known that you did not have BP, then you could relax and investigate with your T other ways of understanding your condition.

When I suspected I might have a certain diagnostic condition (based on what a friend of mine was convinced I had and she is a trained T) and then I discussed it with my own T and she said I did not. It helped me a lot to move myself away from thinking that theory was my problem.

And if you don't trust his answer, tell him that. Honesty is the best way to interact with our T's. Whether he is trustworthy or not, your lack of trust will be a signal to some stuff that's going on in your life.

why isnt he able to diagnose?

also, i wondered about your answer to his question....how would it be helpful for you to have a formal diagnosis?

I have read a book called something like "Why Am I Still Depressed" and it described symptoms that may indicate BP II - I can realte to many of these as it is presented in the book - switching from overly confident and thinking that great things are destined for me to feeling so low and suicidal; I usually have a million and one jobs on the go at any one time and never finish any as I am always side tracked onto something else - My brain does work really fast and sometimes I can't think straight as there is so much going on up there, other times it feels like I am wading through mud. I can go from being very witty and the life and soul to really shy and closed down, I have constant anxiety. I have about 20 mental helath / psychotherapy books by my bed that I am reading - haven't finished any of them and switch from one to another I am prety sure my T is aware of these. Recently I have experienced peoples faces as strange to look at and I have also just remembered being depressed quite a few years ago and I met someone who I concluded was Jesus

However I do understand the difficulties with diagnoses - actually that book I read was great at explaining how very difficult it is to give accurate psychiatric diagnoses and they are really based on likelihood of having symptoms that many others with the label X also experience.

How would a label change things for me? In some ways it would explain so many of the difficulites and oddness I have experienced for as long as I can remember. I have always felt a bit different and it would be a relief to know that it was due to something other than my inner being. However I also think I might find this particualr label quite scarey, particularly as I have intrusive thoughts most days and have read there is a risk of acting of them.

In terms of talking to my T about trust, I feel I am damned if I do and damned if I don't. If I do ask him, it would mean trusting him and therefore as I am having some doubts re: trust I am not sure what that may achieve.

Hey Soup,

Perhaps you could go to your doctor or go to a psychiatrist and talk to them about the symptoms, that way they may have a better idea on how to help or if you do infact have BP II?

I think the book you read is right in saying that it can be hard to diagnose certain conditions as the symptoms overlap other conditions but perhaps a psychatric assessment and working with a psychiatrist over a period of time would give you the answer?

It sounds like you have felt upset about this for a long time.

Yes I guess that would be the best way forward in terms of getting a diagnosis / label. I'm trying to chill about it, and tell myslef it isn't important - but it is...I think? Thanks for everyone's advice.

I will share my experience with diagnosis with you.
I entered into psychotherapy with a psychotherapist I chose by asksing for a referral from the psychoanalytic institute near me. I wanted that kind of therapy. I also like to read a lot and after being in therapy for a while, I read books about Borderline Personality Disorder and thought that it fit me. I asked my therapist what she thought. She told me that she'd thought very early on that BPD fit me. But she didn't share it with me for 2 reasons.
One is that my former T, right before this one, slapped a diagnosis on me that I felt was not me and I was shocked at the abuptness of her doing that and by the diagnosis she was offering. I told my current T that I felt bombarded with that diagnosis; so she did not want to do that to me by presenting a different diganosis, and that one in particular.
Secondly, she says she encourages her patients to not get hung up in the diagnosis. It is a label, a brief way to describe many things.

She has never referred to the diagnosis again. My therapy isn't about how I fit the label, it is just about me and my difficulties and about learning more about myself.



P.S. I am excited to see you have a Pema Chodron quote

"Why am I Still Depressed?" is an excellent book, particularly good at explaining the bipolar spectrum. If you do suspect you may have bipolar disorder, is it important to have good diagnosis as certain medications can cause serious problems with mania, particularly SSRI anti-depressants. If your t is unable to diagnose, you might should seek out a pdoc or psychologist who can. Certainly you need a diagnosis if you are planning on medication treatment.

Therapists are clinicians and can diagnose many mental health conditions. If they are not trained to diagnose a specific condition they may refer out for a diagnosis if there is a benefit to that. (For example, my therapist suspected I might have ADHD and referred me out to talk to a clinician who is trained in diagnosing ADHD and is able to prescribe for it if necessary.) You do not need to go to a psychiatrist for a diagnosis of many mental health disorders.

I think this is an excellent question. My T and I don't dwell on diagnosis and he doesn't talk about it to me. I don't think it would benefit me to have a label or think there is something pathological about myself. My T focuses on health rather than pathology. People can feel stigmatized by a label or start focusing on all that is "wrong" with them rather than developing further all that is positive about themselves and that they have potential to be. Also, if a client is focusing on a diagnosis, they can use that as the explanation for their symptoms and develop a fatalistic view, e.g. "I am emotionally volatile because I have histrionic personality disorder, so therefore, there is nothing I can do to change that about myself" and they won't work on trying to overcome their dysfunctional behaviors.

Even if a T doesn't talk about a specific diagnosis with you, he may have something in mind because it could help guide what he does with you in therapy. For example, my T and I did a lot of trauma work early in therapy and he probably thought I had PTSD--I think he mentioned it once after we were done with the trauma work. But it was never necessary for him to come to me before or during treatment and say "hey, sunrise, you have a diagnosis of PTSD." He just said we are going to use these techniques in therapy because I think you have experienced some traumatic events and that is causing you difficulty today. Let's try these techniques and see if they help.

I don't think his style of therapy--not emphasizing a diagnosis even if he has one in mind--means he is patronising you. It could very well be a positive thing that he does deliberately. I have never felt patronised that my T doesn't focus on pathology. I feel empowered because he focuses on health. If you are feeling patronised, though, then I think it is important to let your T know how you feel. It could harm the therapeutic relationship if you feel this way so addressing it directly with your T could help.

Talking to him would help you understand why he does therapy the way he does, and let him know how you feel. It would help your communication and your relationship, help you understand why you want a diagnosis and help him understand that too, and perhaps give one to you if it seems like it would benefit you. I don't see any down side to talking to your T about trust.

Good luck. Hope you will check back in and let us know how it is going.

P.S. I am excited to see you have a Pema Chodron quote [/quote]

Yes she is great and I have read a few of her books - she writes in such a down to earth way - have also seen her interveiwed on a U Tube clip and foudn her so engaging.

Thank-you for this - it makes so much sense and the logical / rational part of me is trying to convince the anxious bit of that too.