Am I expecting too much?

Just wondering if I have the "right" to be upset with my therapist. It's okay to say I'm being unreasonable. In fact, I'd prefer it if people told me the truth. I'm not going to get offended.

Anyway...

Long story short, I have a bipolar 1 diagnosis, and I get psychosis regardless of my mood. Basically, the psychosis is almost always present to some degree. It's not always severe, but it can be.

Whenever I am in a manic episode, my therapist never tells me. She only tells me about the manic episode after the fact. Even when I'm experiencing psychosis, she doesn't say anything to me.

Only recently did she tell me I was experiencing psychosis. She bluntly said, "You're psychotic right now" and indirectly threatened the hospital. Then she secretly told my psychiatrist that I was psychotic. And I know she secretly told him because his assistant called ME telling me to come in for an appt because my therapist had left my psychiatrist a voicemail. But other than that one time, she has NEVER said anything to me.

Am I being unreasonable by expecting her to inform me of mood shifts? Last session, she kept telling me about all the "unusual" mannerisms I was having during my last manic (not psychotic) episode. For example, pressured and disjointed speech, and racing thoughts. But why didn't she tell me about those symptoms in the moment? I mean, I have a full-time job and I was probably freaking people out without realizing it. I live alone, so I really have no one to tell me these things, and I know that my coworkers would probably feel it's not their place to tell me that I'm "acting weird."

She basically just talks to me during those "manic" sessions and says, "Well, we can wrap up this session early if you have nothing else to talk about." But I'm so bad at identifying manic episodes that I literally have NO idea I am experiencing them. I've asked her before to tell me if I'm experiencing mania, but evidently she likes to do it after the fact.

Have you asked her why she never tells you in the moment? I'd be really upset too...

It's understandable to be upset! Maybe you could talk to her and explain just how important it is to you?

I don't think you're expecting too much, but on the flip side, maybe she doesn't realize you could actually choose to control your behavior if she did inform you. In that case, pointing out your weird mannerisms wouldn't be helpful, it would just make you feel embarrassed and socially anxious. Or, she may assume you are aware of your own mood shifts and behavior - if it's really dramatic, it's possible she just doesn't comprehend how you wouldn't be aware. I would just talk to her and explain that you have trouble in the moment identifying what's going on, and you would find it helpful if she shared her observations with you. Are you positive she doesn't tell you? If you're manic and having racing thoughts, are you really able to listen and take in information? Just wondering. Is there anything you can do if she does tell you?

If she's not good at helping you become aware of when you're manic and/or psychotic, you can probably develop some tools to help yourself identify those times. Even if you only know that you were having an episode after the fact, you could try to come up with a list of symptoms and behaviors that you experienced. Then you could make going over the list every day a habit. If you notice you're starting to exhibit the symptoms you usually do during an episode, you'll know things aren't fine.

Yes, I would be upset too as I would like to know when I was going through these episodes.

Worse, you asked her to tell you, yet she still doesn't. If a client has awareness of what is going on, it then becomes possible to do something about it. I don't get why she is withholding this info from you.. Has she said / have you asked her *why* she won't tell you in the moment. I think this is a conversation worth having.

I would also be very upset by her saying: It's *your* session and hence, *your* time. Even if you were to stay silent or stare at a piece of furniture for the duration of the session, she ought to respect that and not shut the session and/or the client down. Her deciding to kick clients out early is far from professional.

For me . When my therapist says I am psychotic and having delusions, it just angers me because I feel he doesnt believe me. It's only after the fact that I realise he was right .

Some therapists just dont know how to deal with psychosis though.

What's the feeling that underpins expectation?

It seems completely reasonable for you to ask her for that here& now feedback . You could phrase it has a therapy goal to become self- aware in all states? Possibly, she will have reasons she does not, but she should share those with you on a good stretch. I admire your desire to know and be told about yourself; it resonates with me that you need to know how/ when you are affecting people at work. You seem like a very good, hardworking client in this post.

No, I honestly haven't, but I should. You're right.

Yeah, I have to figure out how to explain the importance of it to me.

I generally function pretty well when I'm on my meds, but I'm virtually nonfunctional when I'm off them or in an episode. I know she knows I'm nonfunctional because I've called her outside of appts before and told her I was struggling and why. She even said last session that I "don't appear to function well sometimes." So, it's not like she doesn't know or can't tell.

I'm positive she doesn't tell me. She has never mentioned the racing thoughts, pressured speech, etc. in the moment. So, I'm pretty clueless at the time. I would definitely listen to her if she said I had them, though.

If she told me about the stuff I say/do, I would probably work from home to avoid doing anything socially unacceptable/confusing at work, such as talking nonsensically or doing "crazy talk" and thus making my coworkers very perplexed. (I can work from home whenever I want, but it's "strongly encouraged" that I go into the office, so I go into the office a lot.)

I do like your suggestion about writing down symptoms and reviewing the list everyday. That's a great idea! Thanks.

I haven't asked her why she doesn't tell me, but you're right that I should ask her.

And yeah, she does end sessions early sometimes. I don't know why she does it. Maybe it's selfishness on her part. You know, she might be thinking, "I could sure use the extra break time between appts. I'd like a longer break time."

Yeah, I do get a bit upset when my therapist says I'm psychotic. She basically lets things get to the point where they're "bad" and then secretly rats me out to my pdoc. (She's done this at least 3 times before, even though one of the times I actually agreed to talk to my pdoc. Like, I promised I would talk to him, and I guess she didn't trust me because she called him anyway!)

Maybe I should get a new therapist...

When I was experiencing psychosis, she kept telling me she couldn't help me and that I "have to use meds to cope with it." She never bothered teaching me grounding techniques or anything...

I'm not in your shoes, but it seems fairly clear cut to me. You know that you experience a decline in your functioning concurrent with these episodes, so it would be beneficial to you to know about them during, rather than after the fact.

Yep most therapists and pdocs think that psychosis just requires medication .

But research shows that psychotherapy can be beneficial , specifically CBT based therapies

I'm thankful to have a therapist who is well versed in psychotic disorders

I think it is quite possible that not all therapists are terribly able to work with clients in psychosis. They just don't have the knowledge and training. This may be the case with your therapist, in which case it might be better to find one who knows how to deal with clients with psychotic disorders.

I would find a different therapist that has dealt with psychosis. Most therapists will not work with psychosis without the client being medicated. Look up CBTp.