[chihirochild]

So one of my new Ts (aka new-pdoc aka male-t)... I told him that my SH has gotten like an order of magnitude worse*.

I guess maybe I was hoping he would express sadness or dismay or concern... that he would seem to give a s#it. But he just asked a few follow-up questions (when, where, how), said "maybe this is something you need to do right now" and moved on.

(Yes, yes, I know: it's likely that this is one of those t things--he was Normalizing and Not Rewarding Self-Destructive Behaviour or Using Reverse Psychology or God knows what else. Intellectually I get it, but it still didn't feel great... because to me the fact that it's taking increasing amounts of SH to control my distress is yet another sign that I am really unwell right now, a sign that I need more support that I'm getting. I have already said these things directly to him and to female-t but they haven't f#%cking DONE anything about it and I thought maybe just maybe this would get a response out of him. That isn't why I escalated the SH in the first place... but I thought maybe it could have a silver lining.)

I didn't tell him that his response made me feel worse (it's hard for me to think on the spot in therapy) but I did tell him a related truth which is that a part of me holds onto the hope that if I get sick enough, someone will swoop in and save me... but having that hope makes me worry about how much of my depression and related behaviour is volitional.

Y'all I just feel so so awful all the time these days

*

Possible trigger:

I've been SHing for a long time but I had never actually cut myself with a knife... until last week. Now I look like somebody sectumsempra'd me.

[malika138]

I'm sorry this happened to you. He clearly doesn't understand the pain that drives SH.

[CantExplain]

What do you want T to do?

[satsuma]

I think it could be a good idea, at your next session, to say the things you have written above to T: you feel you are unwell and getting worse, you feel you aren't getting enough support, and last time you shared this you feel T didn't do anything. You could ask what is T able to do to support you, and what is the plan going forward.

I think it will be a good idea not to accompany this discussion with mentioning SH, because of what you mentioned above- that T will be wary of responding directly to that kind of communication.

My T did not really discuss SH behaviour as such with me. He did remark that it doesn't solve any of my problems and it makes me feel bad about myself, and that's what he thinks is bad about it. We have more focussed on resolving the underlying problems, and then the need for SH went away as life got better, for me.

I hope you feel better soon.

[SalingerEsme]

I wish he was more hands on in taking care of you, giving you a big box of alternative ways to create dopamine, distract yourself etc.

[chihirochild]

Originally Posted by CantExplain

What do you want T to do?

I think I would have liked for him to make some kind of nonverbal gesture showing that the news saddened him--something indicating that he gives a crap about me and is sad that my depression has gotten this bad. Him taking it in stride supports my really-difficult-to-uproot belief that my suffering doesn't matter, that there are lots n lots of people out there who have it worse than me (which is true), and that depression = me being a lazy and ungrateful piece of crap. (And that belief just makes me wanna be dead.)

(I get that this isn't necessarily what he was communicating by being matter-of-fact--he made zero explicit statements to this effect--but this is how the lens of my depression warps the input into my brain. I know better than to believe this... but it's hard to, like, use my cognitive brain to change the way I feel.)

[Shazerac]

I don't have personal experience with SH. But I've read books about it. It sounds to me like he's using the standard psych playbook, as in not reacting. It sounds painful for you that he did not respond in what you felt was a caring way. I'm so sorry you are suffering with this.

What concerns me is that your SH is getting worse as you said. As others posted maybe you could devote some time to thinking what is your definition of "help" Do you want to go to the hospital? Do you need to be on meds or different meds. Do you want an emotional response from your T? Do you need more sessions? A different T?

I know it's difficult when drowning in a quagmire of depression to be able to think straight. But try to be your own advocate and speak up for what you want and need. You may not get it, but at least you tried.

[chihirochild]

Originally Posted by satsuma

I think it could be a good idea, at your next session, to say the things you have written above to T: you feel you are unwell and getting worse, you feel you aren't getting enough support, and last time you shared this you feel T didn't do anything. You could ask what is T able to do to support you, and what is the plan going forward.

I think it will be a good idea not to accompany this discussion with mentioning SH, because of what you mentioned above- that T will be wary of responding directly to that kind of communication.

My T did not really discuss SH behaviour as such with me. He did remark that it doesn't solve any of my problems and it makes me feel bad about myself, and that's what he thinks is bad about it. We have more focussed on resolving the underlying problems, and then the need for SH went away as life got better, for me.

I hope you feel better soon.

Thanks. I have communicated everything above except for asking what the plan is. That's a good idea, I think.

Whenever I say the things about how I feel real really bad and seem to be feeling worse and worse, he and female-t (they're in the same office and work closely together--it's a long story) say I hafta trust them and be patient, that if I hafta go to the hospital for a while so be it. I think part of the reason they say that is because I haven't been seeing them for very long 'cause I just moved to this city like 3 months ago and it took a looooooooong time to get set up with therapy even though I started looking 3-4 mo before I moved--I've seen male-t like 5 times and female-t 3 times. Also, unlike my former care team, they're used to working with really sick folks who have quite serious mental illness (i.e. PTSD, schizophrenia, bipolar d/o, BPD--my former care team was more used to people with neurosis or mild depression.) So having a patient go to the hospital is kinda whatever for them, even though it'd be a huge disruption in my personal life.

Part of the problem is that they both have really full practices and say they can't see me very often--female-t can see me once a week for an hour and male-t (who is a pdoc and does my meds in addition to therapy) can only see me every 2 weeks for 20-60 min. (Though female-t does say she'll try to give me extra time if she can.) And my insurance is such that I can't switch Ts unless I want to pay out of pocket, which is $250/hr where I live.

(I have definitely thought about just saying screw it and paying out of pocket, but it took so freaking long to get things in a reasonably stable place with these two Ts and it felt so so awful to be in t-limbo that I don't want to open up that can of worms again, especially not when I feel so bad. Something to keep on the table, bot not something I think is wise right this second)

[satsuma]

((hugs))

One thing that I found good was using therapy to plan for when you're not feeling good, outside of therapy and between sessions. I didn't do DBT therapy but we did go over those kinds of skills, and I ordered the DBT workbook as well which I've found really good.

I do get what you're saying, that because your Ts work with lots of serious cases and are not phased by things, it can seem as if they're not really taking what you say seriously. I think I have sometimes felt that way as well. But on the positive side, I think it shows that they are very experienced and confident in what they are doing. In my opinion that's a good thing and very important.

I hope you can have more conversations about this with T and ask about the plan. I think it would help.

I hope you feel better

[toomanycats]

SH is generally not the problem -- it's a coping mechanism for dealing with something. A maladaptive one, but a coping mechanism nonetheless. There's little to be gained with focusing on SH directly in therapy. The way you deal with it is by addressing the root issues that are causing you the pain that you are trying to cope with through SH.