Decompensating and T Seems Completely Oblivious and/or Doesn't Think It's Serious

I had my first session with my T after a 3 week break due to a natural disaster. I usually see her twice a week. The session wasn't great. I didn't want to look at her. I felt rather glum and sorry for myself from the beginning, and things didn't improve as we talked.

At one point, I feel like she was a little blame-y about my depression. She asked about my job. I said I was working this week and not really looking forward to it (dreading it actually, but I didn't say that). She asked what that was about, and I explained I didn't anticipate enjoying it much, and there are parts which I actively dislike. She asked me if I wasn't going to enjoy it because I wouldn't "let myself" enjoy it. This felt really unfair. I am dealing with crippling depression where I enjoy very little, if anything. I don't think you should have to work hard to enjoy something. That just seems ridiculous to me.

I just felt so hopeless and alone when she was talking about "letting myself" enjoy my job, getting out more, and trying to socialize. I understand she's saying that she doesn't think my depression can get better while I'm completely isolated, don't do anything enjoyable, etc., but I feel so terrible that I feel incapable of doing more than I am currently doing. Which, now that I mention it, is getting to be less and less. I am decompensating and can barely manage to get out of bed, feed myself, and bathe. Sometimes I do none of these things, and only get out of bed to feed my dog.



The session was yesterday. Today, I was doing so badly that I was unable to make it to work. I put my boss in a terrible position, and understandably got in trouble. I am a contractor, and they have cancelled my work for the rest of the week, as well. This is obviously a hit financially (and it doesn't help that I hadn't worked the previous 3 weeks due to the natural disaster).

I texted my T that I didn't go to work and that I think I might get fired. She responded that I should try to go tomorrow and that it's beneficial to me. I replied back that they have cancelled all my work for the week. Haven't heard back from her yet, if she responds at all. It's not looking like she will.

I feel like such a **** up, and the way T is responding isn't helping that. It feels like she thinks I'm just being lazy and choosing to be depressed. I don't WANT to feel so awful. I don't WANT to feel so hopeless and stuck.

I'm feeling really alone because my T seems to be ignoring how depressed I've become. She hasn't even asked me if I'm having thoughts about hurting myself or if I'm engaging in self harm.



I usually don't mind that my T isn't the warm fuzzy type... but right now, I could really use a bit of compassion and sympathy, even if it's not 100% genuine. Instead, I feel like T is sending the message that I need to pull myself up by my emotional bootstraps.

TL;DR: I'm extremely depressed and feel unsupported by my T. I am alarmed by how badly I'm doing, but T doesn't seem concerned at all. I don't know what to do and I'm scared.

Reach back out to her and tell her. She didn't pick up on the signs. See if you can find the courage to reach out and tell her. You are hurting. You are struggling. You do need extra support right now. See if you can push aside any thought of not being worth it, not wanting to bother her, thinking that she should have noticed and reached out to you, and reach back out to her.
Getting extra support right now will make a huge difference. It won't make the crap go away, but it will make life a little lighter, a little easier to bear. Just do it.

Tell her what? I don't even know what to say... I guess maybe that's part of the problem.

Besides, when I texted her the first time saying I had been unable to go to work, in her response, she closed with, "Will talk about it on Thursday." That felt like she was preemptively cutting the interaction off. So maybe I shouldn't even have responded again to tell her they had taken away all my work.

I sure understand the fear. I was terrified recently about a medical situation when something fell through the cracks. Eventually the terror spurred me to action, even though I couldn't help but have a meltdown on the phone. It worked out OK, though, because the helpline nurse was able to listen anyway and got the information to message the doctor, who eventually responded.

Can you insist, as you have written here, that you are decompensating and need some extra support? I do hope that she replies about your work situation. I don't see how would be beneficial to you to go in, since they have cancelled your work. Perhaps the next session you all could strategize about how best to go forward? Seems like it needs a plan, not just some stopgap ideas. And your opinions and information certainly need to be a part of that.

Do you think that the natural disaster might have affected you? Maybe that's something that she hasn't considered? I expect that can be overwhelming.

So sorry you're feeling alone. I know how that is, it really sucks.

You know what's going on with you, she doesn't. Maybe if she's OK overall, this is just a little "blip". Hang on. . .Sounds like you're trying to, including reaching out for support here.

Sometimes you have to be very direct and tell T. I'm sorry that you are feeling so bad. It's annoying to have someone basically tell you to pull yourself up by the bootstraps. That's not always possible. I hope you feel better soon.

There's nowhere for me to go in to. My job is walking dogs.

The natural disaster has definitely affected me. Changes in routine are difficult for me, and I had to evacuate the area for 3 weeks, so that obviously turned my life upside down. Then it was upsetting to come back, because that was another change in routine, except it was even worse coming back, because I am completely socially isolated where I live, which is obviously terrible for my depression. I expect she thinks the event affected her way more than it did me, because she chose to stay in the area instead of evacuate, so she had to deal with no electricity for weeks and stuff like that. I'm fact, that reminds me, one time I texted her to make an appointment for when I was coming back. I mentioned how my mother had tried to grab my phone and demanded to know whom I was texting - and then when I finally told her, after refusing at first, she accused me of making an appointment to talk about how mean she was to me as a child, with a sad face emoji. I mentioned this to my T in the text. Her response was she knew it was hard and that her electricity was out again, with a laughing face emoji. Although I felt sorry for her that her electricity was out again, I thought her reply was a bit insensitive. I guess maybe she's just not feeling very sympathetic lately or something.

I do see my psychiatrist tomorrow morning, but I never want to be too upfront with her, because then she'll want to see me again soon. Not only can I not afford that, but it's never provided any benefit, either. So I'm basically just funding appointments to cover my psychiatrist's ***.

I'm going to try being honest tomorrow, but if she says she wants to see me next week or in 2 weeks, we're going to have a problem. She's already pushing it by making me come for a half hour appointment (I have to pay $25 + 20%) instead of a 15 minute one.

I'm sorry you're struggling so much. I know it can be difficult to reconnect with a T after a break. And if she hasn't really been working for the past 3 weeks, maybe she's kind of off her game, too? Like if she'd been seeing you regularly during that time, maybe she'd have been better able to pick up on how you're doing. And I agree that some of what she said seemed insensitive.

I agree that you should reach out to her. Even if she wants to wait to talk about it in session--I think you said you see her Thursday?--then telling her over email that you're really struggling would make sure you'll be able to address it in session. I think the following thing in your original post would get it across well: "I feel so terrible that I feel incapable of doing more than I am currently doing. Which, now that I mention it, is getting to be less and less. I am decompensating and can barely manage to get out of bed, feed myself, and bathe. Sometimes I do none of these things, and only get out of bed to feed my dog." I've found that sometimes you need to really spell out your symptoms, and how they're affecting your life, to a T for them to understand.

It sounds like a poorly executed attempt to help empower you. Or more likely-she's trying to get at a conflict where part of you doesn't let yourself while the other part of you really wants to enjoy things. That sounds more like it.

Is your T psychoanalytic? My T used to say stuff like that to me sometimes.

The former-does that really work for anyone? Ultimately, we hold ourselves back, whether its unconscious or within our control or not...but only until we don't, which is when we are ready or able to overcome the inertia. The latter-the conflict-that can help give people a push in another direction sometimes.

Yuck. Not good timing with the evacuation displacement, when you're already feeling chaotic. Now on top of that, you feel guilty and self-hate for not doing what you 'should 'be doing. Don't be so hard on yourself-give yourself a break.

@LT Unfortunately, my T doesn't do email.

@guileless I think she's psychodynamic. Maybe? Of course I want to enjoy things. I guess I just don't think the issue is about me holding myself back in some way. I mean, we were talking about my job walking dogs, not skydiving, meeting new people, or something like that. There's just no reason that I would not be "letting myself enjoy" walking dogs, because there's no incentive in doing so. I guess I felt kind of insulted because what she asked insinuates that I gain something by being so miserable. Would I enjoy my job if I wasn't horribly depressed? Yes. But it doesn't follow that I can magically cure my own depression by deciding to "let" myself enjoy my job. That's what it felt like she was saying.

i know you do...i was just saying it's a psychoanalytic thing to have aspects of ourselves that conflict. Like someone with survivor guilt, masochism, undeserving. etc.

If your T doesn't get back to you OR doesn't provide the support you need, and since you say you are scared (I believe you.), KEEP YOURSELF SAFE and deal with your therapist later. Call The Samaritans, or call 911, please. And, please update us here, as you are able to. Gentle hugs.

Just saw my T in the waiting room while waiting for my psychiatrist, and she was all, "Hi, FF!" I wanted to burst into tears.

That really sucks.

What time is your appt. tomorrow? How was the pdoc?

Did you tell your psychiatrist how you feel?

Yes, I told my psychiatrist how I felt.

I'm really upset right now because I managed to wake up 24 minutes before my T appointment, which means I won't make it. I texted her to let her know. Can't believe I managed to sabatoge myself like this.

Maybe it wasn't sabotage? Maybe it was self-protection?

I missed an appointment I really didn't want by mistake once. (I tend to be over-conscientious -- or else a complete rebel. This was therapy so I was consciously conscientious.) The T wasn't at all nice or understanding. That sort of settled things. I was upset and freaked out and felt hopeless and rudderless and that there was no safety anywhere. I left him and went to an assessment for an IOP program, and was accepted. (Perhaps not surprising since they could bill my insurance for it.) The program didn't really help with anything long-term, but I did feel fairly safe and hopeful (even if it was false hope) for a few weeks.

Is your t a Gestalt therapist. She sounds very gestalty and like she is trying to get you to take responsibility. I don’t find this approach very helpful when depressed or anxious in fact I find it anti therapeutic because it almost blames the client for their circumstances and as you say you don’t want to feel like that. If we had a choice no one would want to be depressed. Would you consider this missatunnement, therapist burnout/ compassion fatigue or a rupture

@here_today I don't know... when I said sabotage, I didn't mean that I had unconsciously did it on purpose. I more meant that my carelessness was to blame. I feel like I really needed that appointment, so this outcome was not good. A bit disastrous, really.

@weaverbeaver No, she's not Gestalt. I do think she tries to get me to do whatever I can to influence my situation, which is reasonable, but sometimes makes it feel like she lacks sympathy or empathy. However, I don't think she feels she would be doing her job if she just allowed me to wallow in helplessness without intervening to point out things that I do have control over (or that she perceives I have control over). I would define the situation as misattunement.

This is our exchange this afternoon. Maybe she is realizing that I'm actually depressed now. I'm a little worried that she thinks I was acting out, but oh well.

Edit: I don't know why the images were so small. This what it said.

Me: Can't come today. I'm sorry.

Her: Why? Are you coming back next week?

Me: Because I've been too depressed to do anything but lay in bed, and I didn't wake up until a minute before I texted you.

Her: I'm concerned about you and your depression. Hope you will come next week.

Me: I am concerned about myself, too. Part of the issue today was that Dr. Pdoc started me on another medication, Remeron, yesterday. I didn't know how it would affect me and that if I didn't set an alarm, I would be capable of oversleeping to the degree that I did. I've been resistant to trying anything that might make me gain weight, but now I am desperate because my bad thoughts have been increasing and I need that to stop. Better to be fatter than dead.

Her: I hope the medication will work, may need to increase exercise which would also be helpful for depression.

Good, it sounds like your T is being more attentive to your feelings of depression now. I hope you feel better soon.

Well she doesn't sound psychoanalytic but she seems a lot more than misattuned. She sounds inexperienced or not meeting you where you are at or something.

You have a harsh superego and beat yourself up a lot, but her words add to it. You can see a pattern in only a couple of posts of interactions. I wonder if this is a regular pattern for you both? If it is, wonder why she doesn't see this.

Conversation 1: express dissatisfaction about your job. She tells you you are not letting yourself enjoy it. Then as you said, you felt hopeless.

Conversation 2: you say you can't even get out of bed and too depressed to do anything. She mentions exercise in a closing line, giving you something else to beat yourself up about (perhaps later for not being able to get out of bed to exercise)

From my perspective, it does not sound like an empathy deficit. I get that she may not want to leave you wallowing in depression, but it sounds to me like she reinforces your depression and makes you feel more hopeless and powerless. If you already beat yourself up a lot, as many do, this approach will make it worse. Maybe it would be better if she could lend you some temporary strength to pull you out of this spiral.

Thanks, guileless, I do think she is having trouble feeling empathy towards me for some reason. She is definitely not inexperienced, as she has been practicing for more than 30 years. I'm trying not to take the exercise comment in a negative way. I think she was responding to my fears about gaining weight on the new medication. Although you are also correct that given my current level of (non) functioning, suggesting I integrate additional exercise into my life is giving me another goal I'm not in a good position to achieve at the moment. I need to focus on regaining a baseline level of functioning, where I am getting out of bed sometime in the morning, going to work as I'm supposed to, and doing my schoolwork.

Gosh, this sounds awful. I wonder if your t is burnt out or suffering from compassion fatigue!
She is very challenging and often that’s not really very helpful when we are in throes if depression.
It sounds as though you just wanted her to listen and to try and understand your experiences and how difficult they are right now.
Sometimes my t does similar by saying well whose choice is it to blah blah blah ... it makes me so angry that I have to tell her really? This is not helping, so she says what do need right now. I tell her to be quiet and just listen.

T texted me Sunday evening saying she hoped I would be able to come to my appointment on Monday and that she hoped my weekend was better. Nice of her to reach out. Hope she's not too cross with me for messing up and missing Thursday. Really don't want her to think I intentionally stayed home... it was totally the new medication.

For some reason, I feel apprehensive about my appointment tomorrow. I guess I feel a bit guilty for all the bad thoughts I've been entertaining for the past week, even though I didn't act on them. I feel guilty for harboring information that could be used to harm myself.

You are going to the T to help YOU, not her. If she's cross, she's cross -- that's her lookout. I hope you can find some way not to let that impact you (much) although I know that's hard.

Guilt is a tough one. I deal with that, too.

It does sound as if the T is trying. . .in addition to being "trying" sometimes. I does seem nice that she reached out -- didn't have to do that. I can understand your being apprehensive somewhat, though . . .can you identify what about her causes the apprehension besides what you mentioned? Certainly her seeming dismissal of your feelings and concerns sometimes. And your concern about her possible anger. Anything else?

Hopefully the appointment will go well. Please let us know.