Couch 218: Northern Minnesota 2050

Everything will be okay eventually.

Pandemic just means lots of places and we can actually even treat the plague now though with tetracycline and an aminogycoside antibiotic.

(Sorry I'm just proud of myself for actually remembering something pharm related because of watching Sketchy doodles .)

How far did you go?

Just went to a Starbucks about 15 minutes away and then back home.

It's the most exercise I've gotten in weeks. I know that's pathetic.

I really don't think it is. Anything is better than nothing. Well done C.

Thanks, Lemon

God, I'm tired of cramming for this exam. Only three more hours today and then I can stop. (I take the damn thing on Friday and never study the day before a massive all-day exam so tomorrow I'm safe... though I have other crap to do tomorrow so I'm not off scot-free.)

The stupid thing is that I don't even know what I'll do once I'm done. I mean, the night after the exam I'm going to hang out with some other doctor friends (including a friend from residency who is taking the exam the same day). But I don't start work until mid-September and I have practically nothing to do until then.

Congratulations Doctor C!!

T in a little over an hour and I have no idea what to say.

T's annoyed at me and I'm mad at him too. He thinks I'm not trying hard enough. I think I'm trying as hard as I freaking can.

It seems like you're already being pretty hard on yourself in general lately. What would it look like to your T if you tried harder? I don't think you can berate yourself into feeling better, although I completely understand the impulse to try.

He wants me to spend time thinking about how I embody the sick role to elicit caretaking behaviours from others and to reflect on the ways in which I use self-attack to avoid my desires and feelings.

The problem is that when I try to reflect on these things I get overwhelmingly anxious and my brain clamps down and I can't think.

I think my T is just so dogmatic about his understanding about personality disorder pathology that he refuses to acknowledge the fact that there is such a thing as biological depression that a person can't think herself out of.

(Aka he's an ignoramus and a jerk.)

It seems like his insistence on you seeing and acknowledging your "pathology" is part of what keeps you "sick" (or stuck, at the very least). My DBT T believes that there is no such thing as a bad "part" of the self and that every behavior (no matter how maladaptive!) arose for a particular purpose at a particular time.

So for example, yesterday we were talking about the part that calls myself a monster for wanting care and attention and how it's clashing with another part that feels like I need help and deserve to be cared for. She was talking about how I need to hear what each part needs and see where they can come to a consensus. The "part" that calls me a monster makes me feel awful, but it's really in agreement with the other "part" in that they both want me to have healthy relationships. So I don't have to disavow that part but rather find a way to understand it and reassure it that I can have healthy relationships without being so mean to myself.

I'm pretty sure this is all internal family systems, not DBT, but it's one way to help reduce the inner turmoil I feel without a bunch of negativity and berating. For all your T seems to think you have a PD, he sure doesn't seem to know what to do to help you manage your symptoms...

Hey couch, just popping in on lunch. Training is going well today, again learning lots of stuff that I could have used the past 2 weeks but better late than never right? This knowledge is definitely going to be put to good use going forward. I already feel much better equipped to handle the new responsibilities I've been given. I 'see' L after work on zoom today; really don't know what to talk about. My dream maker has not been showing me much lately, and the only writing I've been doing has been for my current class... oh well, I'm sure we'll figure out something we always do. That bad bout with anxiety that had me wanting to go back on meds was pretty much cured by how much it would cost to go back to pdoc. Well, that and I did some qi gong last night (thanks sd) and then slept like a rock, I'm feeling pretty relaxed and positive about everything today. Also I haven't looked at the news on TV in probably 4 days so that has helped too. And, I snoozed for 30 days several people on facebook which has also helped!!

I asked T if he believed in the biological underpinnings of depression and he got angry/defensive. He asked me if I believe in the psychological underpinnings of depression. He reminded me that I started feeling bad when J first said he wasn't sure about things with me and that things have gotten worse and worse since then. He said that my relationship with J is making me not engage with therapy and making me have SUI and that it's dangerous and I should break up with him.

I don't know about all that but I do think I'm going to break up with J. The thought of hanging out with him is just not appealing. And the fact that I hoped he was calling to break up with me the other day is pretty effing telling.

Oh, EM. I wish my T were more like this. This is a kind and gentle way to approach these things rather than a punitive and angry one.

I thought they weren't supposed to tell clients what to do. He seems very keen on telling you you're not engaging in therapy in the way he wants you to.

what NP said, I thought too that t's aren't supposed tell clients what to do. hugs, chihiro.

Yeah. He can be very directive. I don't really know why.

Why do you put up with him? Granted, I did not mind interviewing therapists. It was like glimpses into their cult - but this guy has a lot of the boxes checked on the list of bad therapist traits. Blog Therapy, Therapy, Therapy Blog, Blogging Therapy, Therapy,..

I would not be able to deal at all with one of them who thought they got to be directive at me.

I'm not really sure.

Got targeted by a thief today...new phone stolen, sent me straight into an anxiety attack. I feel like this week is out to get me. I want to sleep for 100 years.

It's refreshing to go to session knowing that she's going to help craft narratives like this, rather than expecting to argue and go on the defensive when your T blatantly disregards your autonomy. This T is an LCSW, and I have found that those types are very "up with people." It's helpful just to know that she isn't going to tear into me for one thing or another but instead try to understand whatever messed up thing I'm saying.

I also think debating the biological and psychological underpinnings of depression creates a false dichotomy. I like Alex Korb's book Upward Spiral for exactly that reason. Depression is a consequence of all these complex, interrelated circuits in your brain that aren't working well together. The circuits in turn influence (and are influenced by) your environment, thoughts, and behavior. It's fascinating, complicated stuff that explains why no two people have exactly the same experience of depression. (Pardon me for brainsplaining to a doctor, but neuroscience and behavior are kind of my jam. )

Hmm. I would just say that J is kind of an echo of your (and my) parents. "I dont like that you sing, i dont like this, i dont like that. Why cant you be good enough for me? Just jump this high. No i meant this high."

What is J's story? That you are going to be the one to love him after all the others have failed.

Your t may be trying to push the ugly truth in your face. That doesnt make it any less ugly, or any less truthful.

I know - you dont want to end up an old lady regretting the things you DIDNT do. But regretting the things you DID do, when there were other old regretful ladies yelling STOP! STOP! - prolly isnt the best path either.

Is it necessarily dysfunctional--or a manifestation of a PD-- to elicit caretaking when one is tapped out of self-care? It just strikes me how not cognizant he seems to be of the realities that govern your professional life: high stress, brutally high expectations, a mandate to suppress your emotions in the moment, the pressure of a novel pandemic, work hours that impose physical stresses, and the incessant demands to take care of others. These are very good reasons why rates of depression, alcoholism, etc are so high among physicians. I suspect he wouldn't last a week.


Of course your brain shuts down at the prospect of yet more anxiety. That seems protective to me. It's been my experience--and I'm an exceedingly analytical person--that insights cannot be summoned through linear thought. They arise organically in their own time and when stress is low enough that it is safe to have them. He's not helping to create that environment. It may or may not be beneficial to break up with J; but in terms of lessening stress in your life, it seems like breaking up with your T might be more useful.

I agree with this (though haven't read the book!). My T has also said that...now I can't think of what the term he used was, double-something. But that I have both genetic and environmental causes for my anxiety and depression. That I'm genetically prone to it, but that my parents also contributed to my anxiety. (When T said, that, I said, "So basically I was doomed?") Plus my current life situation contributes to both.

And I agree that your T shouldn't be telling you what to do, Chihiro.

I agree with this as well. It makes me think of when ex-MC told me, when I was worried that I was being needy, that it's OK to have needs, that's it's a normal part of being human (or something like that).

just had another pretty darn good session with L even though at the last minute i was filled with anxious energy and didn't want to dial in because i didn't know what to talk about. we found our way as usual. and i left zoom first haha so i didn't have to feel hung up on!