[Hans_Olo]

Hello,

I'm in a great need for an advice on whether I should look for a new therapist or stick to the current one. I have had some mood problems (insomnia, sadness, anger, thoughts of suicide and self-harm, and now a hypersomnia) for about 1,5 years and wanted to consult a specialist, but due to countless doubts I avoided doing it. (The main being a thought that I will be a burden, diverting attention from the people who really need help). Also I knew nothing about psychotherapy. In my country (Ukraine) we don't really talk about such things.

At the beginning of the summer I began chocking and after several different doctors I was referred to a psychotherapist. I came to his office and had an appointment that lasted about 5 minutes. I told him about the chocking, he asked me maybe two questions (one of them about my sleep and another about the chocking feeling). Then he prescribed me Paroxetine (I think it is called Paxil in the USA) and let me go. I wasn't able to tell him about my mood problems that day. I blamed myself for this event and ended up cutting myself. Nevertheless I took the prescribed pills and waited. I can't objectively judge if they were effective, or there were other factors at play, but I didn't experience such severe lows as before. But chocking and bad mood continued, periodically. At last I got fed up with this and came to therapist's office and told him that the medication stopped working. (I really had no way of determining that, I just were afraid that he'll throw me out if I had no solid reasoning for coming back). This meeting also lasted rather briefly. He said it's an anxiety disorder, doubled the antidepressant's dose and prescribed some antypsychiotics. I asked him about non-medication methods, hoping he would offer some talk therapy or CBT. He said that there are at least 6 methods and he'll tell me about them, when he comes back from his vacation in 2 months. It happened so that I was put into an infection ward soon and haven't tried the new drugs. During my stay at the hospital and the following months I had almost no symptoms for the first time since the beginning of 2014 and thaught that I'll be fine. But recently I had a breakdown and everything came back. The psychotherapist I visited works at the city's suicide center together with several psychologists, so I tried visiting them instead while my doctor was on vacation. The psychologist was really nice to me and I was able to tell her everything I wasn't able to tell before. I felt great after the session. But then she said that I must tell the therapist about me not taking drugs and then, after the aforementioned drugs would relieve my symptoms, only then we would be able to work on things like my self-esteem. Unfortunately, I hadn't the guts to ask what to do if the drugs would be ineffective. She also promised to tell the doctor the things I couldn't tell him myself.

Yesterday my psychotherapist came back from his vacation and I paid him a visit. As it turned out the psychologist was ill and didn't tell him about me. I wasn't able to connect again and we only discussed the meds. I told him that I had started taking the prescribed antypsychiotics and they were making me terribly sleepy. He lowered the dosage and told to come the next week. During the whole session he hadn't asked a single question. Afterwards I felt horribly, I wanted to mutilate myself, to have never been born. Thankfully, my mother was fantastic and managed to relieve my distress.

So now I have a dilemma: to search for the new therapist or to stick to the current one. I plan to visit him at least one more time the next week when the psychologist will come back from her sick leave. I understand that there is a great difference in the healthcare systems and approaches to the psychotherapy in Ukraine and the USA, but people are not so different everywhere, so your advice would be of a great value to me.

Hi Hans. If you know of another psychotherapist that you might want to see, it seems like changing might be a good idea. It is troubling to me to hear that the current person you see has taken so little time to talk to you, especially the first time you met with him.

I know that I don't always get as much time as I need with my meds prescriber, but the first time I saw him, he did spend an hour asking me questions and taking a history.

Also, do you mind describing your choking feeling in more detail? Is is like temporarily having your throat close and you can't breathe? Or is it different?

I am also curious if you have chronic medical problems/health conditions. I am asking about this because I do, and went through a period where I was experiencing having my throat close off just for a second or two and I wouldn't be able to get a breath. I was also having problems with depression and anxiety at that time. The problem went away, and I was never really certain if it was caused by anxiety or if it was related to my medical conditions.

I'm glad that you've come to this forum. It is a great place to talk about your concerns and to learn and to offer support to other people. We mostly all try to share with each other and support and help each other.

[mcl6136]

Oh dear. I am a somatizer (one who experiences physical symptoms of mental distress....a patient with physical complaints for which no organic basis can be found). This means when I am distressed, I get gut-aches, headaches, chest pains, muscle spasms. Are you perhaps experiencing something similar with the choking?

Only through a sincere inquiry will you ever really know.

It seems to me that your doctor -- if you can find a good one- should be parsing what parts of your distress are due to organic issues that could escalate, and which parts are your body rising up to get your attention....your body shouting to you about your mental health/stress level/emotional wellbeing. But the first doctor that you mention was not listening, probing, helping, guiding you in the direction of authentic inquiry. That doctor just got out the MEDICATION! And sent you on your (not-so-merry) way.

I'm a big proponent of doctor shopping. If you were buying a vehicle, would you simply turn the key and drive away in the first one that you test drove? Or...a sweater....wouldn't you try a few to determine the best fit? Regarding one therapist, you reported, "I felt great after the session." That is useful data, straight from your body!

Was that great feeling because the therapist listened with compassion? And you felt that you had someone in your corner? You say that this therapist worked at the city's suicide center, correct? Is it possible that the therapists who work there are extremely attuned, compassionate and emotionally available.... while the therapist who spent a matter of minutes with you was merely writing scripts and moving onto the next person in the timetable? IF this is the case, perhaps your body was telling you: more listening, less medication. Can you listen to your physical self? Am I even on remotely the correct track here? These are important signals from your corporeal self, it seems to me and you ignore them at your own peril.

Could it be that healing could come when you have someone in your corner? You make this point about your mother, as well. I'm glad that you have reached out to this superb group and I wish you the best of luck.

Please keep us posted.

[Hans_Olo]

Thank you very much for replying!
The chocking feels as if somebody slightly strangulates me or a feeling of tension in my throat. It's not very intense and I can deal with it most of the time, but it can be problematic to fall asleep. Sometimes it coincides with anxiety, sometimes not. Usually the feeling starts several hours after waking up and worsens till the evening. Sometimes the chocking serves as an early sign of the coming anxiety and bad mood. I have no chronic diseases and I have visited several regular doctors before being sent to a psychotherapist.
Actually, both of the therapists work at a suicide center, the first one was a psychotherapist (let's call him Jo) and the second one is a psychologist ( let's call her Jane). Now the center is closed, so they, together with like 5 other people sit in a tiny room with only three desks (good bye, privacy). Jo is the therapist assigned to me according to my address. Every time I visited him I felt like ****. I thought, that maybe, I did something wrong. I wanted to hurt myself. Every time I told, tat I won't be hard on myself, but I failed each time. Then, I talked to Jane because Jo was on vacation. I think the best in that conversation was the fact that she seemed to care, ask lots of questions, etc. She told me to come back (Jo never even mentioned this, never made appointments) and said that there is a lot work to do. I think this is the most important thing, giving me hope, something to work towards and a kind of promise not to abandon me. But when she heard about me taking the medicine and having trouble staying awake due to it, she told me to visit Jo. I understand that she did so. She isn't a doctor and didn't want unexpected consequences, but I am afraid that she won't treat me until I have my anxiety and chocking "cured".
Anyway, I'm going to visit my therapist one more time, maybe try some new approach. And if it fails, I'll search for other options. Thanks for the support.