What the psychiatrist said

This might also trigger other people who are sensitive about having a long term therapy relationships. I'm so nervous about actually starting a thread. It feels so much more exposing, and risky, because I might sound like a complete idiot and be impossible to reply to! So anyway, here goes.

I've just finished my first ever appointment with a psychiatrist. I was surprised that it was an hour and a half. So I was given the diagnosis (which fits and I've always felt sure of anyway).

I have a close relationship with my therapist. She's helped me in a way that no one else ever has. She's been the first solid,consistent and reliable person I've had. She always helps so much. There is no question in my mind, I want to keep working with her. I feel it's important and the first real chance I've had to heal things from the past, by having someone who does not leave or give up on me. When I finish, ideally, I want it to be because I've moved through the dependency I'm currently experiencing. I'm fairly sure I'm learning to be more independent all the time. I want to leave once I am able to feel more sure of myself, because she stayed as this consistent reliable base of support when I've most needed it.

The psychiatrist talked about the dependency as a bad thing. He talked about putting things in place so that leaving my therapist would be easier for me. He told me that when a therapist and patient have been working together for a long time, that the patient cannot see the therapists faults, and the therapist cannot see the problems the patient is presenting with. I don't think my therapist (like me) is faultless. Sometimes when either of us has made a mistake, we've worked through it, and that is what has helped me the most.

Maybe I've answered my own question. I'm going to discuss this in therapy next week, but I wonder if this will put doubts in my therapists mind? Is it possible to keep benefiting from a long term therapy relationship? I'm not ready to let go yet!

I don't agree with this at all. Good relationships take years to build and I'm not going to throw that away.

The truth is that a theraputic relationship is one of, if not THE toughest, relationships out there. There are so many feelings, thoughts, issues involved. You get very close to a perrson, and not just anyone- one who knows all of your secrets, feelings, etc. ]

I think there is some truth to what your psychiatrist was saying... a relationship that is longterm can have its faults, but only if there is no progress being made. I think that as long as you are continuing to make progress and learn new things about yourself and working on the issues that are there, then there is no problem with a longterm relationship. For instance, if you are truly working on the dependancy thing with your t, then great! I don't see any problem with that. But if you are working on it for years, say, and you still don't have the connfidence to leave, and sesion after sesion is spent "working", then you may have a problem. see the diference there?

Hope I made a little bit of sense, lol...

The psychiatrist has a different point of view. He dispenses medication and doesn't provide therapy. It's okay to disagree with how he thinks he might do therapy, and it has no relevance to your therapy and therapy relationship.

I think it is sometimes helpful to hear others perspectives as it is an opportunity to reflect and see whethfr their view fits us as individuals. Their view is just a view and not necessairly a factual reflection of us.

Thanks so much for the replies! They honestly help a lot. I managed the appointment so well, and most things were so positive, but that was one thing which was just going to drive me crazy until I had the chance to say something about it to someone. I don't have any one to discuss it with other than my therapist, so thanks for being the ones who heard me. It makes it a little bit easier to let go of until I can discuss it further.

I disagree with him. As I've gotten to know my therapist, I've seen her faults and weaknesses, as well as her greatness. She is far from perfect in my eyes, but I have learned that perfection is overrated.

Together, we have better understood what my problems are.

When I first started seeing her, she would never acknowledge that I was "abnormal". It used to frustrate me because to me "abnormal" is a value-neutral word. If she couldn't at least acknowledge the most obvious thing about me, I didn't see how I was going to be able to go far with her. But eventually she has come around...as I have. I don't focus so much on abnormal vs. normal, and she doesn't attempt to normalize everything about me. She is more comfortable telling me the unsugar-coated truth. That kind of honesty only comes with time.

Some issues can be addressed with short-term therapy. Some problems require longer-term treatment. And then, in the case of supportive therapy, it can be any length. It's too complicated to "should" on anything.

If you see your relationship with your T as a positive thing in your life, then that's what matters. I think some people get to a place where they can't make any decisions at all without their T, and that's probably not a good thing, but you seem to have your own mind in all of this.

I am learning that there are certain degress of dependency. Some people have a greater need of it than others. Some are overly so, others not enough. I think that is between you and your T to find out and investigate.

If you are just now starting meds (or starting better meds) it sounds like you are still in a fair amount of distress. I think if you are still having problems significant enough to prompt psychiatric intervention, it is not a good time to stop therapy!

Also I have found that stabilizing on meds helped me dig deeper and get more out of therapy. You may be starting a whole new chapter!

Best,
EJ

Well, there's dependency and then their DEPENDENCY. Remember, this pdoc is really talking about dependency as a general concept because he doesn't know you well enough yet to really know whether your dependency on your therapist is a healthy, therapeudic dependency or an unhealthy dependency that is holding you back from making progress. If you have a healthy therapeudic relationship with your therapist, just take what the pdoc said as his own generalization rather than a specific comment about you and your T.

Thank you so much everyone for the helpful and positive comments. I appreciate them all.

I did not have a good relationship with relatives when growing up so it has been very difficult for me to get to the stage where I've allowed myself to begin to depend on the help and support as something stable. I've taken a long time getting there and now that I have, I feel like I'm making more progress than ever. For the first time instead of falling to pieces every time something goes wrong, and barely hanging on until my next appointment, sometimes I'm managing to cope with it on my own, because I've come to depend on the stable, reliable, and wonderful person who has helped me to change my life around. I feel like I'm just getting to the place where the real work starts (even though I've worked so hard the whole time). It's only now that it's begun to be safe enough to share what I've needed to talk about all along. I feel like the dependency is helping me to become independent. I tried to say some of this during the pdoc appointment but it wasn't really heard.

I agree with the others that say that psychiatrists are generally not well trained in therapy and they don't necessarily know your therapeutic relationship. Thus, his opinion on whether you are dependent and whether that is harmful to you is unlikely to be very accurate.

I would turn it into a discussion topic with your T, as in:

1) Am I dependent on you? In what way(s)?

2) Is this dependency unhealthy for me? In what way(s)?

Sometimes it is useful to explore whether there is that kernel of truth in things said to us that we don't agree with. Sometimes not so much

Same here. I like the way you put that!

I would go further. Psychiatrists and Psychotherapists are natural enemies!

My doctor said pretty much the same thing to me that I was in therapy for too long, after six sessions and that he doesn't. Think it works at all!

My therapist was a psychiatrist - a rare feat these days. The one I see now is a psychologist - who, at first, was an advocate for short term therapy. I think though, now, he is in it for the long haul - especially as he has gotten to know me a bit.

I think therapy is beneficial, but it depends on how you use it. I strongly believe that if we go to therapy and simply complain, then get our complaints validated, and feel better about being miserable - then it's time to move on. Clearly, this is a part of therapy especially at first, but it's always good to look at it and ask if that state is where we are locked.

Therapy is about change. I think long term therapy can bring about long term change. It can be corrective rather than "white knuckling" it through life.

If you are comfortable with your progress then by all means stay the course. Inside, we are our own best healers. We just have to pay attention to ourselves.

Mine aren't. They work quite well together and consult each other about my treatment.

That's a little extreme, CE. They do work together all the time, so they can't really be enemies. During a time when I took anti-depressants, I had both a psychiatrist and a psychologist.

My first T was actually a psychiatrist. He was awesome at therapy. He later went on to train students in clinical psychology.

My T -- who is also a pdoc -- does that as well. And he's the first T I've met who has been open to discuss things like the therapeutic relationship.

Psychiatry and psychotherapy are two different disciplines, though some individuals have training in both. And as with everything else in life, some practitioners of one of the disciplines don't know enough about the other one, and are suspicious of it. It's human nature. But most of the practitioners are positive towards the "other discipline", fortunately.

I had my first appointment with my T after the psychiatrists comments. She wasn't particularly impressed with the comments and I was able to talk about how I handled them and why I think the level of dependency I've developed (trusting that support and the person who supports will be there when I need it) has actually helped me a lot.

All of the comments I received here helped me so much. I guess I felt like this authority figure had come along and shaken up the one thing that has been so good and helpful and stable for the last few years.

I think not long ago comments like that would have put me into such a spin that I'd have seen the whole appointment as a disaster, but actually this time, though I was worried, I managed to let go of the unhelpful stuff and just focus on the positive aspects of the appointment. The helpful comments here really helped to make that possible for me, and it was such a big improvement for me to be able to do that, that I wanted to say thanks so much for the support everyone! It really helped.

Hopefully, your therapist will allow you to be yourself. If you start talking about dependency, hopefully your therapist won't insist that it is his way or the highway. Hopefully, your therapist will realize that the fear of separating is intense, that any subtle hint of him/her leaving can unwittingly aggravate OCD, especially if it isn't talked about verbally. Like if you become obsessive and he just gets angry and responds with boundary after boundary instead of saying, when you did _____ it felt like ________ so you could actually process it instead of being retriggered. If he responds with, here is a boundary, there is a boundary, and is responding in a reactive manner, he will be ensuring that your OCD presenting as dependency will escalate. When this happens, he can present a case that you are not trying hard enough, that you are not progressing, and he can blame it on you. He can then starting questioning you if you can work on ending your dependency, which escalates the fear, and then actively point out that since you are not following his God-like advice, that you are the problem and that he can't help you because you aren't helping yourself. He will fail to recognize if you become dissociative and disoriented if he is using methods involving manipulation, but will use this to his advantage. But he won't admit anything, he won't say that he is to a point that he will no longer be able to deal with the dependency, and you will end up in hell, reliving it over and over again and he will no longer care, or may care but will refuse to own his own stuff. I'm sorry, but this was my experience and I wouldn't want anyone else to go through it. HE GAVE UP ON ME, decided not that he couldn't be my therapist anymore, but that he wouldn't. Then he spent awhile trying to get this to be my idea. He ****ed up and will never have the courage to admit it. He will never care or acknowledge what he did to me. It will always be my fault because I'm dependent and he will invalidate anything you think or feel, and he can because who would believe someone who is in therapy. Sorry for telling my story, it is not every story, but it remains a possibility. Be careful, please.

Also, I took six weeks off from therapy, which to me, shows that I WAS making progress in therapy, that I WAS trying to reduce my dependency. THEN he used it against me, saying that if I needed to take off from therapy in order to work, that the therapy wasn't working. This is where it all started, so who knows, maybe he has a fear of abandonment that I triggered. So, I came back from this and it was over before it started. I would have worked on dependency, whatever that would entail. But I needed to feel safe again after all of the things happened, and he couldn't see that. I had just had the courage to take off, I SERIOUSLY thought he would be impressed (not that it should have mattered), and instead of using this as a springboard to work on dependency issues, he saw it as a negative. I still feel disoriented. I feel selfish for talking about me, so I'm sorry.

"Reducing dependency" is very much a long term goal. So long, in fact, that it doesn't really count as a goal at all.

Raise a child right, and she will decide for herself when it is time to move out. And therapy is the same, I think.

Thanks for sharing your story with me. I can almost feel inside me how painful that would be to go through. I know how hard it is to build up that dependency when you've never had it, how hard it is to trust it, and how dreadful it would feel to have it ripped away before managing to learn to hold on to the good aspects of it, when it would feel ripped away and like you're left with nothing.

The psychiatrist was very negative about the dependency but my therapist isn't. I think she feels the same way about it as I do, that at this stage it's okay. I'm learning to be more independent because of it. It feels like it's helping to heal something that I've carried with me for a long time. Right now, I need to depend on her help. If I was to lose it too soon, I'd be devastated as well. Unless something really changed (moving locations, something out of my control), I think my therapist is sticking with me.

I think you're right. I grew up not depending on anyone. I had no idea that you even could! I think I need to work through this. If I don't learn to depend in a healthy way, I think there is always going to be something awful that I carry with me in life, that was never allowed to heal. I think the psychiatrist was wrong.