Couch 232: Not Sully!

Morning couch. Hugs/headnods all around as appropriate.

Had a quite fruitful session with L yesterday. We did some good dream work with 2 of the dreams I'd brought with me; I had some rich material built up after 3 weeks much of which I had already worked with, so I just kind of listened to all of it for what wanted most to come and brought only a fraction of it so we'd have time and not have to rush through any of it. That worked out well so I will do the same before my next session in a month. We'd been doing 3 weeks between, but I decided yesterday to see how 4 weeks goes - I am thinking that ideally, I would like to settle into seeing her once a month for awhile. I feel like I am (finally) actually in charge of my process now, much more than I ever have been in the past and that feels pretty darn good.

It's super windy here today and 70 degrees, blue sky with fluffy white clouds, a beautiful day here in the desert! So I'm going for a walk while it's still cool. It's a fun time of year to walk in my new neighborhood - since there's lots of families with kids here, the halloween decorations are plentiful!

NP- Your ex was abusive. A friend who is unwilling to believe your own experience of your own relationship, all of the parts this person didn't see, is not much of a friend. If this is the friend you've mentioned before, this isn't the first time this has come up with this person. I wonder if discussing the past with this person might be something to avoid.

oh happy day. I just learned that our bankruptcy came off our credit reports yesterday! I thought we still had a few months to go til it came off.

Glad to hear it, Artie!

After 6 years i finally bought a new diniing suite and got rid of the last thing associated with my ex the old dining set which was given to us by his parents, after they had got 20 years use out of it. I finally found i was able to sit at the table and eat a meal without being anxious but i hadnt realised i had been anxious until i ate at the new table and noticed it was pleasant and relaxing. Its it strange how anxiety became so familiar you think thats how normal feels. The pain in my stomach after eating has eased.

I hear that. I cant even use my electric juicer without thinking of the late mr luna, even tho its a different one. You know, the one where you smash half a citrus on it and it spins.

Oh i love Jon Batiste! I never watch Austin City Limits but he is on tonight and he is just precious.

I read all your responses to my post last night. I just don't have the emotional bandwidth to respond today. I had a very difficult session about this issue this morning. Thank you for all your support.

I'm freaking out! We have decided to move asap because we can't afford our rent anymore and we're not on a lease. We're hoping to move before they evict us.

Moving is stressful! Finding a place is stressful! Trying to convince an apartment complex that you have 5! emotional support animals is stressful! Selling and giving away stuff is stressful! I am so freaking overwhelmed!

(Please no judgements!)

I understand my ex used justbsay we are moving just because the rent went up $5 a week which wasnt much, and we would have to find somewhere and move in 2 weeks, not because of the rent i think but because he was from a military family and was used to moving every couple of years. If we couldnt move he would have a major change of all furniture. It was chaeper to move than buy all nmew furniture every 2 years.

Okay, I'm annoyed. Visa finally got her client portal working and I logged on to pay. (Not with Visa.)

I'm using insurance for her because Info is expensive enough and I don't think Visa will last anyway, but also because she had to give a diagnosis code (and I forgot to ask her what it would be at the appointment). Diagnosis code is fine, but she chose "Adjustment disorder with mixed disturbance of emotions and conduct." Which not only do I not like the sound of, but the various clinical literature makes it sound like 1) an overreaction and 2) something temporary. A disability isn't temporary, and I don't see myself as overreacting to a situation in which I essentially had to get my own accommodations (I didn't go into details on here, but that's what happened). I even get the emotions part but not the conduct part--it's not like I'm behaving badly). I feel like I've been made to sound like some kind of enfant terrible. (Quiet, una! )

So I'm annoyed. The sensible side of me reminds me that it's just a code (I was actually even prepared for adjustment disorder), she needs to give one, possibly there were no better options, I could afford not to use insurance, plus it's better than the psychiatrist who put in a code for Generalized Anxiety Disorder (at which I'm still rolling my eyes).

Didn't you say that Visa listed working with people with hearing impairment as a specialism? If that is the case, it seems odd that she'd be so callous with regard to something that is a permanent feature of your life.

I haven't followed everything about Visa, but she doesn't know you for that long yet, so a specific diagnosis is probably hard.

However, correct me if I'm wrong, but as far as I can see in the DSM-5 there is no mention of the persistence of symptoms. In the DSM-IV there seems to even have been a chronic version.
The DSM-5 also lists significant impairment in social, occupational or other important areas of functioning, which to me means "conduct". In the broadest sense this could include not wanting to shower for some length of time, not wanting to go to a bar because of association with previous experiences. (Table 3.19, DSM-IV to DSM-5 Adjustment Disorders Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health - NCBI Bookshelf)

The way Visa sounds, I can totally see her just go by the DSM definition without considering any kind of more in depth literature and how it sounds to the client or other clinicians...

An adjustment disorder is temporary; even though your disability is permanent, the difficulty you're having related to it is temporary (in the sense that the emotional turmoil this situation is causing you now won't last forever).

An adjustment disorder does not mean that the person's response is overblown or overly dramatic or outside of the norm or anything. It just means they're having difficulty coping with it (or adjusting to it). At least, that's how I interpret the DSM. It's often just as much (or more) about the crappy situation the person is in as it is about the person themselves. It's the interaction between the person and their environment. But I'm a social worker, not a psychologist.

However, you could experience another bout of "adjustment disorder" 4 years from now when there's another new technology that doesn't work for you but which your uni requires you to use, and they again refuse to provide an accessible version of for you. In that case, you would presumably be re-diagnosed with an adjustment disorder, which is just appalling!!!

I hope Visa is at least helpful.

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I don't get the sense that many T's think too much about the diagnostic code they use--I think they just make sure it's one that's covered by insurance. When I saw R, the backup T, a few times, she used the Adjustment Disorder code. Dr. T just uses the one for Major Depressive Disorder, even though we often talk about my generalized anxiety and OCD--but he doesn't bother putting those on there. (I self-pay but then submit to insurance for partial reimbursement, so a code of some kind is needed.)

So it's possible that Visa just puts that diagnosis down for all clients (at least in the beginning) because she knows insurance will accept it as a covered diagnosis. Could be something to bring up to her though maybe?

I got certified in medical coding (cpc) and adjustment disorder is a super common Dx used for therapists esp with a new client

It's like a basic catch-all Dx

I really wanted a job doing coding but the ce credit courses were so expensive that I couldn't upkeep my certification =[

The exam was super intense. It was six hours straight with no breaks. 150 questions that require u to find the correct icd codes for all scope of illness and procedures.. It was super hard. Apparently it has a 50% pass rate. It took me 3 tries to finally pass it. My 2nd attempt I failed by 4 questions!

It's getting colder with the wind, I turned on my furnace. I'm excited for winter, it's my favorite time of year (sans holidays tho)

I got the same sense from L as LT said about diagnostic codes, I recall that she used Adjustment Disorder as well the last time I attempted to get reimbursed from my insurance. I never asked what she was using 10 years ago for the short time she actually accepted insurance I assume it was a depression one back then.

Goodness I don't feel like working today. I want to go outside! It looks lovely out there outside my office window. Thankful for working at home I can at least open my window! Oops, break time's over gotta get back to work. Hope everyone is having a good day/night depending on where you are. Hugs and head nods all around as appropriate.

I had never heard of adjustment disorder. Having consulted Dr Google, I see that I, and everyone else I have ever known, has adjustment disorder because when stressful and unpleasant stuff happens people find it hard to manage the stressful and unpleasant stuff. I thought this was life. Maybe therapists and insurance companies could invent a code for "life" being the presenting issue.

To be honest the term just makes me think of chiropraxis.

We went from winter straight into summer it has been brutal. No sign of spring at all.