[CantExplain]

TRIGGER FOR SI







If I were a therapist, I'd say that not taking you meds is equivalent to self-injury. It would be both uncaring and unprofessional for me to ignore it.

I don't know the right thing to say, but I'd have to say something. You might receive that as pestering, nagging, anger or even bullying. But as long as you are under my care I will take care of you.

Just my opinion.

I might agree that it is potentially self sabotaging... but I wouldn't consider it SI. There are lots of reasons people stop taking meds, and I don't think they suit everyone. In the UK prescriptions are just £7.20 (or free if you're on benefits) but I know cost is a factor in other countries, depending on insurance coverage.

Stopping taking/refusing to take pills that may or may not help you, doesn't seem quite the same as picking up a blade or a lighter to your own flesh. Not to me, anyway.

(But, FYI: I do take my meds, as I believe they help me to function and prevent me from crying - for the most part at least... )

Absolutely, although my T has never talked about it in terms of self-injury, he does feel like I am sabotaging my recovery if I mess with my meds in any way without first talking to my pdoc. And he's right. He feels the same way if I purposely don't get enough sleep. And he really gets aggravated if I try to do a marathon grading session. All of them really mess with bipolar disorder by triggering hypomania.

So I do call my pdoc first. Fortunately I have a pdoc who returns calls promptly.

But self injury? I wouldn't go that far; neither would my T or my Pdoc.

[stopdog]

I would think that position just encourages non disclosure.

[venusss]

Depends why are you doing it. If you are doing it with "**** it all", then possibly yes.

If you hate being fat asexual zombie as reason for non-adherence... eh, then could it be really considered SI to try to stop? I think it's more hating the way you feel and you be considered more of self-medicating. (or self-non-medicating. It makes sense. You take drugs when you like how they make you feel. If you are supposed to take drugs and don't like the way they make you feel... then not taking them is... about boosting your feelings. Not causing deliberate harm).

Originally Posted by VenusHalley

If you hate being fat asexual zombie as reason for non-adherence...

Lol, yeah, that's no fun! I think in the case of feeling like a 'fat asexual zombie' - it happens! - it's sometimes good to review meds with a doctor instead of quitting them altogether - sometimes they can try you on something that will work better without the unfortunate side effects.

As someone who writes prescriptions every day- not just for psychiatric medications- I find it very frustrating when people don't take their meds as directed, especially life-saving ones. I try to explain the risks, benefits and consequences for every medication I prescribe. However, in the end, it's the patient's decision. If you cannot bear the side effects, than you have the right to stop taking them. Of course, if I think you are deliberately sabatoging your health, than it's my right to stop seeing you.

Every provider places the bar in different places on this issue, but it is generally accepted that non-compliance with medication can be a valid reason to terminate care. I would imagine it is similar with a t.

[WantingtoHeal]

Eww...I have a lot of trouble with this one. Never thought of it as SI or non-compliance. I frequently will change my meds around...change doses, skip doses, try different things and not tell my doc. I keep all my prescriptions that I've ever tried. I get very very scared of side effects and I panic at times that the meds are doing something weird to me. Also, I hate being a zombie and not being able to concentrate. My mind used to be very sharp. I've been on anti-depressants for the past 28 years and my brain feels like mush now. Also, I don't feel like the docs listen to me or know what they're doing. I'm taking a leap of faith with my new doc, now, and trusting him and doing exactly as he says. I'm not sure how long I'll give him, though.

[healed84]

I agree that it could be self-sabotaging.. However, the reasons are soooo complex that I think it is hard to make a wide assumption or judgment like you have made. I refused drugs for months, then avoided taking them for almost two weeks after I filled them. Not b/c I didn't want to get better, but b/c my anxiety, intrusive, irrational thoughts got in my way. I do not consider that a form of SI.. I have struggled with SI, it they comes from two totally different thoughts and emotions. Other don't take them b/c money is an issues, or they can't stand the side-effects, etc.

[stopdog]

Any therapist with the attitude of "i [B]will [B] take care of you" would be a therapist i would not get near.
I have never taken meds of a psychiatric sort, but I the few times I have gone to an md or had meds prescribed for something, I have probably not followed the advice and I have suffered no ill effects. I suppose if I started suffering ill effects, I would follow more until I achieved the results I wanted. It is, after all, my life, not that of the therapist or md or chiropractor etc. Just because I seek information, I am not then compelled to use the information if I choose not to nor am I compelled to use the information only in the way the distributor of the info wishes. I get to choose or change to someone who will not try to bully just as the bully can choose to only engage with those who submit.

[pbutton]

I have a PRN medication which I probably don't take as often as I should. So I am semi-compliant.

I definitely would not want a therapist to tell me he'd take care of me. To me, the point of therapy is for T to help me figure out how to take care of myself.

[FourRedheads]

I don't know. I stopped taking Zoloft about a month ago because I was concerned about weight gain and I felt weird while on it. I haven't told T about this for many reasons but I know that I need to tell her this and I will. Just not yet. I don't think that means I am SI or being non compliant.

[learning1]

Originally Posted by stopdog

Any therapist with the attitude of "i [b]will [b] take care of you" would be a therapist i would not get near.
I have never taken meds of a psychiatric sort, but I the few times I have gone to an md or had meds prescribed for something, I have probably not followed the advice and I have suffered no ill effects. I suppose if I started suffering ill effects, I would follow more until I achieved the results I wanted. It is, after all, my life, not that of the therapist or md or chiropractor etc. Just because I seek information, I am not then compelled to use the information if I choose not to nor am I compelled to use the information only in the way the distributor of the info wishes. I get to choose or change to someone who will not try to bully just as the bully can choose to only engage with those who submit.

If one of your law clients was completely sabotaging his case in some way, but wanted you to continue being his lawyer, would you do it? It seems to me like the professional has some responsibility to support the client in making reasonable/good decisions if the client isn't doing it on his/her own. Otherwise it might not be ethical to continue taking the clients money. But if the client still wants the professional's help, it gives the professional some reason to support the client more strongly (if the professional feels confidence that the client could be helped.)

I'm thinking of situations where not taking meds leads the client to very self-harmful actions, like having delusions that could cause him/her to unknowingly walk into traffic or some dangerous thing like that.

[learning1]

Originally Posted by lucydog

As someone who writes prescriptions every day- not just for psychiatric medications- I find it very frustrating when people don't take their meds as directed, especially life-saving ones. I try to explain the risks, benefits and consequences for every medication I prescribe. However, in the end, it's the patient's decision. If you cannot bear the side effects, than you have the right to stop taking them. Of course, if I think you are deliberately sabatoging your health, than it's my right to stop seeing you.

Every provider places the bar in different places on this issue, but it is generally accepted that non-compliance with medication can be a valid reason to terminate care. I would imagine it is similar with a t.

I agree. i also think our society doesn't usually offer nearly as much support for people to understand and feel supported in making good health decisions as most people need and want, or would want if they experienced more support and knew what it felt like. Just counseling someone for 20 minutes in a doctor's office isn't enough. Obviously tons of people here on PC wish they could talk to their t's more, and we're just the ones who are aware of the possibility of doing better. So many people don't understand the reasons for their self destructive health habits are related to depression. They don't have any idea it's possible to feel better. If access to support was encouraged instead of made extremely expensive and difficult, maybe people would choose to make better decisions more often.

[stopdog]

Originally Posted by learning1

If one of your law clients was completely sabotaging his case in some way, but wanted you to continue being his lawyer, would you do it? It seems to me like the professional has some responsibility to support the client in making reasonable/good decisions if the client isn't doing it on his/her own. Otherwise it might not be ethical to continue taking the clients money. But if the client still wants the professional's help, it gives the professional some reason to support the client more strongly (if the professional feels confidence that the client could be helped.)

I'm thinking of situations where not taking meds leads the client to very self-harmful actions, like having delusions that could cause him/her to unknowingly walk into traffic or some dangerous thing like that.

I did not disagree that someone could refuse to continue working with someone else from either side of the bargain:"I get to choose or change to someone who will not try to bully just as the bully can choose to only engage with those who submit."

As for me, Clients can choose to leave if I do not handle their case they way they want. I can request leave to withdraw as counsel. But I do not get to tell them I get to bully them for their own good nor do I get to decide what is best for them. That is their decision, not mine, even when I would choose something different.

[elliemay]

Originally Posted by CantExplain

I don't know the right thing to say, but I'd have to say something. You might receive that as pestering, nagging, anger or even bullying. But as long as you are under my care I will take care of you.

Well, you certainly could say something about it, or even terminate my therapy, but you're not going to get me to take any med I don't want to without a court order, and even then, well, I would fight that.

I think I'm a little sensitive about this subject because it comes up so often for me professionally.

I would never stop seeing a diabetic the first time they took their insulin wrong. I am going to meet with her (literally) every day if necessary until she gets her blood sugar under control. I am going to try a dozen different medications until we find one that she can tolerate. I am going to print off handouts from websites and discuss weight loss and draw pictures on a white board. But, after a few years of this- including multiple trips to the ER- I'm going to decide that I am just not the right provider for this patient. I'm going to recommend that she see someone else. It is clear that she and I just cannot communicate. I don't speak her language.

Substitue "asthma", or "heart disease" or "depression" for diabetes and this is my daily patient load.

Am I a bully for firing 2 or 3 patients in my 10 year career as a medical provider? Perhaps. But I just hope that their next doc was able to speak their language and reach them.

Finally, I look at myself. My own doctor has written me for pscyh meds and I choose not to take them. I just can't bring myself to. I am the master of my own fate, I am allowed to make my own choices. But, the day he has to visit me in the hospital is the day he gets to insist I start taking that med.

I bet this isn't very interesting to most people, but like I said it is very important to me. Thanks for listening to me rant.

[stopdog]

Bully was the word used by the OP. "You might receive that as pestering, nagging, anger or even bullying. But as long as you are under my care I will take care of you." I have no objection to anyone deciding they do not want to work with someone else. I object to the idea that because I have consulted someone, they get to impose their will upon me. But I make sure I do not put myself in that situation. I do not consider myself under anyone's care.

It's OK. I wasn't offended by the word bully.

I agree- you are not under anyone else's "care". You have the responsibility to care for yourself. That is your own full time job. It's my job (or a t's, or a lawyer's, or a plumber's) to provide an expert opinion. You pay for me for my advice or recommendation. Then, you make your own decision. The end.

On the other hand, just to set the record straight. I do care about my patients. I care a lot, and I can't help but feel some measure of responsibility and personal concern for them. If I didn't, I would find another job. Maybe plumbing.

[stopdog]

I care about my students and clients. It still does not give me the right to do anything other than give them the best advice I have and then to let them choose what to do with that information. Caring does not trump the autonomy of another. I don't really think caring matters one way or the other at all. Whether it is me that is doing the caring or someone else. Certainly not doctors or therapists. Massive harm and suffering have been perpetrated upon other people in the name of caring or for their own good. This is very important to me and my rant.

I hear your rant.

I hate the idea that I might have some kind of control over another person- a patient, a spouse or a family member (part of the reason that I've never had children)- almost as much as I hate the idea that someone has control over me. I would never presume that my concern for someone is greater than their own concern for themself. Or that I know more about what is best for them than they. I also have seen the real harm done by people who then use the excuse that "I was only doing it for their own good".

Again, I don't want to step on you here. I'm pretty sure I agree with you. I am sorry if I'm not expressing myself clearly.

[stopdog]

Originally Posted by lucydog

I hear your rant.

Again, I don't want to step on you here. I'm pretty sure I agree with you. I am sorry if I'm not expressing myself clearly.

I was not trying to step on you either. No worries heres.

[sunrise]

I like what lucydog wrote about how she interacts with and cares for the patients she treats and prescribes for.

I am not that keen, though, on a therapist butting into medication decisions. I think that should be between the patient and prescriber, not the therapist. The therapist does not have training in pharmacology. I do not think it is the T's business, and certainly not within their scope of practice, to be nagging and bullying the patient about what is going on with meds. The T just doesn't have the expertise. If the prescriber is also the therapist, that's different, but not too common these days.

I have strong feelings about this because my first therapist was giving me medication advice (ultimatums, really), and she knew nothing in that area. She was an MSW!! She told me she would terminate me as a client if I ever took psych meds. And she was really pissy about it when I raised the possibility. At the time, I didn't know what to think because I was quite new to therapy, and I was severely depressed. I just figured she knew best and stuck with her med-free approach to treatment, which was a rather mediocre version of therapy. (She would say stupid things like "do something nice for yourself--take a bubble bath." GAG. USELESS. How is that supposed to help? I want to work on my problems in therapy, not talk about taking bubble baths!) In retrospect, I realize that if I had taken meds then, my recovery might have been expedited. I might not have felt so crappy for so long. I wish she had stayed in her own corner. Let the meds advice be given by professionals who know what they're talking about.[/rant]

[critterlady]

The limit of my T's involvement in my anti-depressant treatment is to help me understand whether I might want to talk to my prescribing physician about a dosage adjustment (like if he thinks my mood level is changing one way or the other). He does also help me deal with the emotional fallout from some of the side effects, if they're affecting how I manage day-to-day.

When I told my previous T that my physician had recommended A-D treatment, he gave his opinion on whether he thought I needed them. When I resisted, he backed off for a while, but kept coming gently back to them. At one point, I was getting about 2 hours sleep/night, was crying at almost anything and came into a session and basically just stared at the floor. He pushed me a lot at that point to call my doctor. I did. I trusted his judgment.

[learning1]

Originally Posted by lucydog

I think I'm a little sensitive about this subject because it comes up so often for me professionally.

I would never stop seeing a diabetic the first time they took their insulin wrong. I am going to meet with her (literally) every day if necessary until she gets her blood sugar under control. I am going to try a dozen different medications until we find one that she can tolerate. I am going to print off handouts from websites and discuss weight loss and draw pictures on a white board. But, after a few years of this- including multiple trips to the ER- I'm going to decide that I am just not the right provider for this patient. I'm going to recommend that she see someone else. It is clear that she and I just cannot communicate. I don't speak her language.

Substitue "asthma", or "heart disease" or "depression" for diabetes and this is my daily patient load.

Am I a bully for firing 2 or 3 patients in my 10 year career as a medical provider? Perhaps. But I just hope that their next doc was able to speak their language and reach them.

Finally, I look at myself. My own doctor has written me for pscyh meds and I choose not to take them. I just can't bring myself to. I am the master of my own fate, I am allowed to make my own choices. But, the day he has to visit me in the hospital is the day he gets to insist I start taking that med.

I bet this isn't very interesting to most people, but like I said it is very important to me. Thanks for listening to me rant.

You sound like a very caring health care provider Lucy. I think diabetes is a great comparison because it also takes a lot of emotional support for a lot of people, since it needs so many behavioral adjustments. I imagine a therapists support could be very helpful for making and keeping those adjustments. I don't know if therapy is commonly recommended or available or taken advantage of, though I know there are some therapists who focus on medical issues. I guess that there would be a lot of crossover between being a medical provider and being a psychological provider with diabetes too. It sounds like you're really aware of the support needs and it's great you're able to spend a good amount of time with patients. i know of some diabetics who got none of that though. I suppose there are issues with some health care providers who are too emotionally detached to know how to help, or even to want to help, as well as issues with insurance that doesn't cover the time needed.

I also agree with you about refering patients on in the situation you described Lucy. I think that's a lot better than a lot of health care providers who just give up and let the patient keep getting worse.