Why talk during talk therapy?

I started a thread last month about a recent diagnosis I received (in the specific forum) and asked for thoughts - I haven't gotten a response yet. So I'm going to modify my question some and start a new thread here. I have a few specific questions, but some background first...

My therapist informed me on our last visit that he and my psychiatrist have concluded that I have schizotypal personality disorder. He handed me a printout explaining what it is and asked that we discuss my thoughts on the matter next session - which is Thursday.

The diagnosis is, in my opinion, ludicrous. Be that as it may be, it's what they've come up with. But here's the thing:

It is my strong opinion that we talk in order to communicate. If after a year of talk therapy they've come up with this diagnosis, one of only a couple of things is going on. They are either right or they are wrong. If they are right and I just can't see it, then my thoughts on the matter are useless. If they are wrong, then a year of talking has been wasted because they clearly aren't hearing me. What has changed to make me think they'll start listening now?

Either way, what could possibly be gained by discussing this with them?

And yet, if I don't discuss it, it seems likely that they'll conclude I'm being hostile. So, why not just tell them what I told you? Well, because again, it seems that I'm not being listened to. Why not change therapists and doctors? Impractical and near impossible. I am so rural that I travel over one hundred miles to talk to my doctor via skype - there isn't many options here. Why am I going in the first place? Depression brought on by chronic pain, accompanying sleep deprivation, a terminal diagnosis and fighting disability for three years while trying to survive with no income. Why don't I quit altogether? My disability lawyer recommends it.

I go in Thursday. Any suggestions?

All the advice I can give you is, go in and tell them literally everything you said in this post, and go from there. At least give them one last chance, and see if you can get them to explain why they believe you have the disorder, after a year of talking. I'm sorry to hear that you're going through so much crap.

Ask them, " now that you've shared my diagnosis, could you please share your updated treatment plan for me, and let me know approx. how many sessions it will take to get better?"

It sounds like you need a sense of direction in this process. Asking this question is entirely appropriate, and, with a terminal diagnosis, you need to be sure that you aren't wasting your time. Any good clinician would be happy to answer this question directly.

I would tell him I'm not really big on labels, especially when I don't have a long life ahead of me, but that I'd like him tell me more about how he reached that diagnosis and if he's sure about it. After hearing his reply, unless he said something I wanted to know more about, I would honestly need time to think about it more. It's an interesting dx.

Ironically, I've told him previously that I didn't care what label got placed on me, but I rather thought it would be reasonable, you know?

It feels kind of like working in a 'right to work' state. They can fire you for any reason or even no reason, but they can't fire you for an illegal reason. I'm fairly convinced that most of the criteria he is using to place this dx on me is centered on my religion/cultural beliefs and a particular skill set I have.

The religious/cultural is simply that I am a Native American Buddhist with a fair amount of crossover between the two. My spirituality is vital to me, and so it's come up some in sessions. I can see where talking to one's spirit animal might seem suspicious to someone with a very narrow set of life experiences. I'm living in a rural, white, conservative, evangelical community that is not very open-minded to outside influences.

From that thread I posted back in November and haven't gotten a response to yet:

Magical thinking: This is a key issue for my psychiatrist and therapist upon which this diagnosis is based (I believe). I think they believe that I think I have special powers of discernment. Here's the thing though (and they know this) I've written a book on body language that got me an invite to speak to a group from the FBI. I've given hundreds of paid lectures on the subject. My skills are world class. Of course I see things that others don't - but not because of some magical ability but a learned skill set that anyone can learn with the proper training.

Honestly look 100 miles the other directions, possibly in the Native American or Buddhist communities, for a new therapist. Are you on any medication to need a psychiatrist? If you take out the cultural parts.

Do you get social anxiety? Is the way you speak (cadence) different then others? Do you get suspicious or paranoid of others? Do you have friends? Are your emotions different then others?

Ask how they ruled out depression, anxiety and psychosis? Ask for another psych exam from a Native American psychiatrist. Tell them you don't agree and you worry it's a culture "thing".

My suggestion is to answer their questions. Is this an SSI examination or a dr helping you get SSI? They dont need your knowledge, they just want your answers to their questions. At this point i am more than a little confused by this diagnosis, but i am not there when you are answering questions. I know it was very hard for me to stay on topic during my interviews.

I think miguels mom makes some very good points also re the culture. Cultural strains, differences, i felt affected me later in my work life.

Oh, this makes so much sense. Thank you for explaining. It's really tricky if the reason you're in therapy is for the disability claim, and you've been assigned this psychiatrist and therapist to work with (military?). I would definitely ask if your spiritual beliefs are being factored into the dx and if so, what might your dx look like if cultural factors were removed?

Example from a different angle: My therapist said I'd been short changed by being diagnosed when trauma symptoms were active--once those calmed down, a whole different picture emerged. You are similarly being affected by a diagnosis that's looking at the wrong thing.

I wish you could see someone more open minded. I've shared spiritual beliefs with my therapist that she said others would have diagnosed as psychotic, but she understood the origin. She's protective in a way, guiding me on what words to use if I do have to interact with other mh professionals so that they don't go down the wrong path.

Misdiagnosis is a real thing. I guess you have to decide if you can live with it as a means to another end and still retain your sense of true self.

Your post sounds very reasonable and carefully considered. Sometimes doctors are wrong. I wouldn't be afraid of expressing your concern to them. However keep in mind that some doctors can't handle a patient disagreeing with them or questioning them. I would have to think that Skype is not an ideal way of diagnosing someone. Best wishes.

I tend to be really solution based, believe it or not, so I'll admit to feeling some awkwardness brushing off very reasonable suggestions but...

I am on the Canadian border - so north is not an option. East of here 20-120 miles is quite literally White Supremacist central. West a hundred miles is pretty much barren or as rural as it is here.

Here's the other thing: My wife and I are surviving on $6000/year while I await SSDI. I spend $1800/year on gas getting to doctors visits averaging four a week for the last three years. Car insurance is $700/year. That leaves us with $3500/year to live on - or about three hundred a month. We live in a barn. Don't ask me how I afford internet because a truthful answer will have to be edited by a mod. The more money one has, the more options; we are extremely limited.

Yes, but not how I've ever heard anyone else describe it. I am extremely competent socially, but I loath it. I'd compare it to someone working graveyard at Walmart stocking shelves. They don't do it because it is fulfilling; they do it because it is what they have to do to survive. I can fit in perfectly at the White House or the crack house - and have. No matter where I go, I am perceived as someone to get to know. But it's an act, albeit a highly polished one.

Well, I did just use 'albeit' in a sentence. But no.

In my opinion, all people are capable of 'good' and 'bad' - though as a Buddhist, the whole discussion of good and bad is a bit of a non sequitur. I am aware of the capabilities of people - but look for the good.

No. My wife, that's it. I am very introverted.

A very difficult question and would require me to intimately know others emotional range - but I don't think so. I am capable of a wide range of emotions, the only noticeable one missing is jealousy; I don't think I've ever felt that one. Generally speaking, I'd say I have the whole Buddhist equanimity thing going - so perhaps serenity instead of jumping up and down in jubilation or throwing things in anger. On the other hand, if I am 'letting go' via a movie or something, I will cry at commercials, Disney movies, Nicholas Sparks movies require two boxes of tissues at minimum.

I was referred by my primary care provider for depression initially. The psychiatrist decided correctly that I was not getting sleep due to chronic pain, and verified by a sleep study showing 0% stage three and REM sleep. He prescribed something to help me sleep and the depression lifted immediately. During that time, there was also high levels of anxiety and audio hallucinations. But again, everything stopped immediately after getting some sleep.

My health insurance doesn't cover doctors from the reservation, and the local one is my wife's tribe which doesn't cover spouses. I would have to pay out of pocket and that is simply impossible.

Initially, it was neither. I was referred to a psychiatrist for depressive symptoms by my primary care physician. The therapist was mandated as a condition for seeing the psychiatrist. The pdoc determined that the onset of depression was sleep deprivation due to chronic pain. He prescribed me something to help me sleep and the depression lifted.

My disability attorney advised me to continue to go in case they came up with something that would insure disability in the unlikely event that I was denied on physical issues only. An insurance policy, if you will.

I understand your comment that you are not there when I am answering questions; I'd feel the same way. That said, you're getting pretty much the same 'me' that they are.

I know that I think differently. In fact, I've been asked more than once by those who have gotten to spend any real time with me, if I've been tested for Asperger's syndrome. It does not occur to them to ask during casual social interactions, but...for instance:

I live on a horse ranch. They give lessons here and board horses in addition to breeding and showing. In my time here, I've noted over one hundred clients. I can tell you two of their names but I can tell you right now, every single one of their license plate numbers. See...even trying to be candid, I withhold information in order to fit in socially. There have been one hundred thirteen distinct plates come on the property - not the vague "over one hundred". I don't know why I retain information like this, but I do.

So this whole 'socially competent but introverted to the nth degree' thing makes perfect sense to me. Me being me creates a social outcast. Me adopting a persona that fits in is disingenuous and as I rather like me, I'd rather be by myself and be me than in a crowd being Ferris Bueller. Hmm, that encapsulated it almost perfectly, well done me.

Not exactly. My attorney simply wants me to continue to see them in the event that they can improve my chances. As you no doubt know, being qualified for disability and receiving it are often two different things. We are going for a slam dunk.

I shall; thank you for the suggestion.

Couldn't agree more.

*nods*, *nods*, and more *nods*.

I have a question for you, if you don't mind. Based on the picture of these two that I've painted, what would you say to the following idea that I dreamed up this afternoon:

As I've said, I do process information differently. For instance, I can't remember a face but can't forget a number. I am considering asking my therapist tomorrow if he or my pdoc speaks a foreign language. I'm polylingual; I can, and have, assimilated languages in weeks. If he does speak another language, schedule my next appointment for three weeks and have it in his second language. If he doesn't and my pdoc is bilingual, well, I have three and a half weeks before that appointment so I'll just keep the same appointment.

Telling them that I think differently is not working. What about showing them? Of course, if neither speak a second language, I've probably dug myself a deeper whole with the whole 'magical thinking' bit. Thoughts?

Oh, how I wish you could see my therapist. She genuinely values people who think differently (and I'm not talking about having different views on issues).

I love your idea about the languages. What I can't tell from here is how they think, and how flexible their minds are or how open they would be to being shown what you mean. If they're entrenched in a particular view of the mind, then that's a problem. I might float it as an analogy, and if there were traction and one of them seemed intrigued, suggest such a session or even a portion of a session to experience it.

So much of it depends on their own views of the mind. Pushing too hard is risky (but you don't come across that way). I would probably approach with curiosity, looking for clarity on both sides, hoping they would reciprocate.

So do I my friend, so do I.

Well, I've been seeing them for a bit now and I really think my therapist would be uncomfortable with the idea, but I think, if only from an academic point of view, my pdoc couldn't refuse. It's a dog and pony show but I really don't think he could resist out of professional curiosity. The part that bothers me is that I am convinced that once successful, he would misinterpret my motives as being almost Trump-esque, when in actuality, he left me with few options. That might leave me in the frying pan instead of the fire...little improvement in actual communication.

I really appreciate the response, I was hoping you'd return to this thread prior to me seeing him. Sincere thanks for your input.

Good luck today.

(I do not think you have to be worried about being Trump-esque. *shiver*)

I'm guessing your therapist isn't going to be more open about this since you haven't posted an update, but just in case...I came across a list of criteria for the dx you've been handed and thought of you: "This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture." (Schizotypal Personality Disorder).

Actually ruh roh, I didn't post an update because I wasn't convinced anyone would be checking back.

*nods* Yeah, my version uses the term subculture but ultimately the same. Anyway, he surprised me and despite asking to talk about this next session, he avoided it completely. Instead, he focused on the brace/sling on my arm and how it was affecting daily functioning in relation to our work and relationship with the boss/landlord.

My wife works on a horse ranch and I help where I can. One thing that I almost always do is drive the tractor around for her while she feeds the sixty-five horses. She can't reach the pedals without coming off the seat and the tractor has a built in safety feature that shuts it off if the driver leaves the seat - so she simply can't do it.

He knows things are tense with the boss, but didn't know how tense until yesterday so he simply took off exploring that. I let him. No sense pushing the stream...it'll get there when it gets there. Anywho, because of the holidays, I don't see him for another few weeks - all in all it was win-win for me.