[nessaea]

Hi all!

Been away for a bit, but back now, and wanted to get perspective on something (and also just wanted to tell someone!)

After two years of waiting/searching for a mental health professional, I was finally (thankfully) referred to a psychiatrist for an assessment. She is wonderful and incredibly smart and I think I would be able to work so well with her.

However, I've seen her seven times now, and she keeps making it clear we are still doing an "assessment". I totally understand that she wants to get a clear picture of me and make sure she can help, and the logical part of me does really appreciate her professionalism that way. But my emotional side feels like I've had this ongoing "audition" or "job interview" (for lack of better words) for weeks now, with no clear end in sight. I'm struggling a bit, because I don't want to invest and get my hopes up just to have her say that she doesn't think she can work with me, but I also know that holding stuff back and intentionally not trusting her and letting her in is probably not helpful in this stage at all.

So, I don't know. I guess I was wondering if anyone had any thoughts about this, or what I should do? Or what other people's experiences have been with the initial assessment phase of therapy?

Thanks for reading!

~Ness

[atisketatasket]

Do you know what she means by "assessment"? Does she mean she's deciding whether she can work with you or not, or that she's trying to get a whole picture of you before diving in deeper?

If the latter, I'm not particularly bothered by the length - I am quite sure No. 1, who I've been seeing longer (about a dozen sessions over 5 1/2 months), might still say she was in an assessment phase before deciding how to help me. If the former, that still seems long, and I'd ask right at the start of the next session, either when she'll decide or what she means by "assessment."

It does seem to me that most mental health professionals only take a few sessions to decide whether or not they can work with a client. Yours has either already decided in the affirmative or is prolonging things too much.

[Leah123]

Hi there and welcome back. My thoughts about this would be empathy as far as that always-interviewing feeling and my advice would be to share what you've written here and ask her straight out what her plan is so you won't remain in limbo.

[Crescent Moon]

Is it a psychiatrist that just works with meds, or do they also do therapy?

Seems unusual for a psychiatrist to take that long to figure out treatment with meds... but if therapy is involved, then sometimes therapists are reluctant to nail down a diagnosis. They would rather work with the symptoms. So in that situation (and that may not be what's happening), I could see them having a prolonged period of 'assessing' a person before coming to conclusions.

[nessaea]

Originally Posted by atisketatasket

Do you know what she means by "assessment"? Does she mean she's deciding whether she can work with you or not, or that she's trying to get a whole picture of you before diving in deeper?

Thanks for the response! I have asked, and the assessment is to decide whether or not we will continue to work together. I tried to ask her (in a roundabout way) last time, and she said that she still needs to find out some more stuff, plus she wants to talk to one of my previous doctors, plus also get me to get a full physical done by my GP (which will probably take about a month to get done) to get an idea of my overall health, before she makes any commitments to taking me on as a patient.

I do appreciate how thorough she is being, I really do. I guess I just feel unsettled and anxious every time, like I need to somehow prove my worth, maybe? I don't know....I guess I'm just being immature about it.

[nessaea]

Originally Posted by Crescent Moon

Is it a psychiatrist that just works with meds, or do they also do therapy?

I think she would want to work with both therapy and meds, if she decides to take me on. Which I like - I appreciate someone who uses a combined approach.

[atisketatasket]

Originally Posted by nessaea

I do appreciate how thorough she is being, I really do. I guess I just feel unsettled and anxious every time, like I need to somehow prove my worth, maybe? I don't know....I guess I'm just being immature about it.

I'm not sure I like the direction this is going. I'd feel the same way about the situation. Have you asked her why it's taking so long? You've been seeing her almost two months and she has no idea? She can't even give you a hint what she's thinking? She has to have some clue.

CM is right, she could be nailing down a diagnosis, but even in that case she's still taking a very long time and I don't see the need for a physical that will add a whole month to your wait, or why the physical would have any relevance except for medication.

[nessaea]

Originally Posted by atisketatasket

I'm not sure I like the direction this is going. I'd feel the same way about the situation. Have you asked her why it's taking so long? You've been seeing her almost two months and she has no idea? She can't even give you a hint what she's thinking? She has to have some clue.

I have kind of asked, and her response was "All I can say is, I don't know." She explained that she still wants to get a better picture, that she wants to touch base with my medical doctor and previous therapist, and that she doesn't know if she is the right person to help me with everything.

I do appreciate it, and I think it's good for her to be really upfront with me if she can't help me, but I guess I'm just worried that it'll be a month from now, she'll decide she can't help me, and I'l have 1) gotten attached/feel connected to her and be a little hurt and 2) be left without support again, and have to go another couple years to try to find help.

[Crescent Moon]

Originally Posted by nessaea

I have kind of asked, and her response was "All I can say is, I don't know." She explained that she still wants to get a better picture, that she wants to touch base with my medical doctor and previous therapist, and that she doesn't know if she is the right person to help me with everything.

I do appreciate it, and I think it's good for her to be really upfront with me if she can't help me, but I guess I'm just worried that it'll be a month from now, she'll decide she can't help me, and I'l have 1) gotten attached/feel connected to her and be a little hurt and 2) be left without support again, and have to go another couple years to try to find help.

You must live in a country with a national health system? I just can't believe how long they make people wait for services, and the limits they place on services. As difficult as the USA system might seem to those in other countries, if you are poor you would have medicaid and would have MUCH better access to services than where you are.

It just seems so wrong to leave someone in distress for such a long time.

[nessaea]

Originally Posted by Crescent Moon

You must live in a country with a national health system? I just can't believe how long they make people wait for services, and the limits they place on services. As difficult as the USA system might seem to those in other countries, if you are poor you would have medicaid and would have MUCH better access to services than where you are.

It just seems so wrong to leave someone in distress for such a long time.

We do have health care services, but I just ended up in a bad situation. Psychiatrists are covered by our health care plan, whereas therapists/counsellors/psychologists are not, and I just don't have the money to see one of them. Usually you can get a referral from your GP to a specialist, like a psychiatrist, within 6 months to a year, but I didn't have a GP for over a year (that was a nightmare on it's own trying to find) and then when I found one, she was new, so didn't know anyone to refer me to.

I finally got a referral to this psychiatrist from one of the doctors who runs a group I attend sometimes (she is friends with this psychiatrist, and knew she was opening up a private practice, so was able to get me in even though she probably shouldn't have) so this was like a rare and amazing opportunity...plus the fact that I really like her is even better. So I'm just worried about what will happen if I lose this, and don't have anything else, you know?

I think I'm scared because I'm not doing well right now, and it's pretty negatively impacting things like health, relationships, work, etc. And I'm worried that if I am not able to find help soon I might end up in a bad place. But I don't want to tell this new doctor that because I don't want to seem desperate, or put pressure on her or anything, because I'm really not that kind of person!

[Crescent Moon]

Originally Posted by nessaea

We do have health care services, but I just ended up in a bad situation. Psychiatrists are covered by our health care plan, whereas therapists/counsellors/psychologists are not, and I just don't have the money to see one of them. Usually you can get a referral from your GP to a specialist, like a psychiatrist, within 6 months to a year, but I didn't have a GP for over a year (that was a nightmare on it's own trying to find) and then when I found one, she was new, so didn't know anyone to refer me to.

I finally got a referral to this psychiatrist from one of the doctors who runs a group I attend sometimes (she is friends with this psychiatrist, and knew she was opening up a private practice, so was able to get me in even though she probably shouldn't have) so this was like a rare and amazing opportunity...plus the fact that I really like her is even better. So I'm just worried about what will happen if I lose this, and don't have anything else, you know?

I think I'm scared because I'm not doing well right now, and it's pretty negatively impacting things like health, relationships, work, etc. And I'm worried that if I am not able to find help soon I might end up in a bad place. But I don't want to tell this new doctor that because I don't want to seem desperate, or put pressure on her or anything, because I'm really not that kind of person!

It may seem normal to you to have to wait 6 months.. but I think its terrible for someone who feels like you feel to be left like that for so long. Its unbelievable to someone in a U.S. health system. Anyway, you need to tell her how desperate you feel and how afraid you are. She might be sensing things beneath the surface that have her puzzled... and are causing the delay. She needs to hear you say what you just told me... that you need help, are afraid to make her feel pressured, but are worried about ending up in a bad place if she doesn't keep you.

[atisketatasket]

Originally Posted by nessaea

I do appreciate it, and I think it's good for her to be really upfront with me if she can't help me, but I guess I'm just worried that it'll be a month from now, she'll decide she can't help me, and I'l have 1) gotten attached/feel connected to her and be a little hurt and 2) be left without support again, and have to go another couple years to try to find help.

If you think she's worth the wait, that's one thing, but it concerns me a bit that you keep insisting how much you appreciate her behavior despite the fact that it's doing you some harm. By this stage, I wouldn't be appreciating it at all. I think you should be upfront with her about the fact you feel you need help now and that this waiting is making things worse for you.

[nessaea]

Thanks all for the thoughts. I don't know what to do. I'm seeing her again today and I'm really nervous. I'm really not doing well, and part of me wants to tell her that, but since she's technically not my doctor, I don't think it's my place. I'm trying to "be good" during this assessment period so she likes me and agrees to work with me, but I don't know how much longer I can go with the "keeping up appearances" act, so to speak.

I know, logically, the right thing to do is just be upfront, but therapy and relationships, and specifically therapeutic relationships, are rarely logical, eh?

[atisketatasket]

Originally Posted by nessaea

Thanks all for the thoughts. I don't know what to do. I'm seeing her again today and I'm really nervous. I'm really not doing well, and part of me wants to tell her that, but since she's technically not my doctor, I don't think it's my place. I'm trying to "be good" during this assessment period so she likes me and agrees to work with me, but I don't know how much longer I can go with the "keeping up appearances" act, so to speak.

I know, logically, the right thing to do is just be upfront, but therapy and relationships, and specifically therapeutic relationships, are rarely logical, eh?

Sure, therapeutic relationships are weird, illogical, and all over the place. What concerns me is that the situation already has you kind of dependent on this woman and seeking her approval. It may not be her fault, but it's clearly causing you problems, and if she does take you on you're already in a pattern of pleasing her instead of looking to help yourself.

[nessaea]

Originally Posted by atisketatasket

Sure, therapeutic relationships are weird, illogical, and all over the place. What concerns me is that the situation already has you kind of dependent on this woman and seeking her approval. It may not be her fault, but it's clearly causing you problems, and if she does take you on you're already in a pattern of pleasing her instead of looking to help yourself.

Understood, and great point. I think I am pursuing it because, believe it or not, this is actually the least "people pleasing" therapy relationship I've ever been in. She was aware from the get-go that I have a tendency to make people happy at all costs, and so she's been SUPER good at keeping her personal preferences hidden. She has actually been amazing at trying to keep the focus on me, and redirects every time I try to find out about her, or about what she wants to stay happy. (Which is obviously why it is driving me crazy)

So, I guess the reason I am confident about this is because she has set great boundaries already, and although they are currently very difficult for me, I think they might be the best thing in the long term.

What I'm saying, very horribly, is that the problems are with me, and not with her.

[atisketatasket]

Originally Posted by nessaea

What I'm saying, very horribly, is that the problems are with me, and not with her.

I think the problems are with the situation, not you.