Confusing First Session

Today I had a session with a new mental health professional with an "NP" as her title. She works as part of a larger mental health group with several offices in the broader area where I live.

I went in with my primary complaint being about being frequently confused, unable to focus, and having memory recall issues. Somehow, in those 15 minutes, she concluded that I was mildly depressed and show signs of psychosis.

I agree with the depression but not the psychosis. I'm not saying that I don't have any form of psychosis, but what information I shared with her cannot possibly be enough to narrow down my problem as psychosis, and its not even in the ballpark for the kind of diagnosis I was expecting, unless I've grossly misunderstood the meaning of psychosis. And when I asked for her reasoning on how she came to that conclusion, she basically told me that it was none of my business and didn't have to tell me because she's the professional with years of experience and I'm not. However, she noted I had trouble maintaining eye contact and implied she believed it was because I was distracted by hallucinations of things in the room. Well, I wasn't seeing any hallucinations, and I told her the reason I didn't make eye contact was that keeping eye contact with someone makes it hard for me to keep my focus. The closest thing to hallucinations I have are that I sometimes misidentify objects in my peripheral as people or other living things as bugs, but when I go to look at them I can quickly see its just a vaguely person- or bug-shaped object. I also tend to have waking dreams if I get woken up during certain phases of my sleep cycle, but those stop after I've fully woken up.

Prior to working with this new person I have already been having sessions for years with a personal therapist, and it has never come up that I might be psychotic, and she was just as confused by the diagnosis as I was. I have had other therapists before this one too, and none of them ever described me as being psychotic. The only things that have been consistently made about me are that I am depressed, anxious, autistic or neurodivergent, and that I may have some kind of personality disorder such as bipolar, borderline, or *possibly* some kind of NPD (although that's more of my own fear than an actual accusation from a therapist).

I will say that there was a bit of a language barrier with this therapist. It's like our dialects were incompatible. She would often look at me after I said something with this blank confused stare, and I would have to come up with other ways to say things until she seemed to get what I was trying to say. That kind of confusion is disconcerting to me for someone who has the power to involuntarily hospitalize me or who may be responsible for prescribing psychoactive medications.

I don’t like the sound of this professional to be honest and I wouldn’t be happy with her refusing to let you know how she came to that conclusion after 15 minutes.
Not all mental health professionals are great and if you feel like it’s off well then there’s a good chance it is! Do you have to see this person again? Were you there for a diagnosis ?

I agree with this comment. They should be able to explain why they came to a certain conclusion. And not making eye contact certainly wouldn't suggest hallucinations to me. It could be anxiety, neurodivergence, any number of things.


NP is most likely nurse practitioner, so a nurse with additional qualifications (can likely prescribe medications, for example).

Are you seeing this person just for a diagnosis? For potential medication? Or for therapy? Either way, seems like it might be better to pursue a different provider if that's at all an option.

I was going because I thought that the kind of help I needed extended beyond just what I was getting from my talk therapist alone, but I didn't know exactly what I needed. So I guess a diagnosis would have been helpful, but I don't know if I had a specific goal other than to get directed to the right place. However, this new person also said that working with her long term would require me to cancel my current therapist so that I can work with one of her in office therapists. I'm not really willing to commit to that because the therapist I have right now has been working pretty well for me for the past few years and I don't want to have to rebuild another client-therapist relationship.

I wouldn't go back to her, tbh. Too many red flags.

Ditto.

She should be able to tell you how you meet the dx. She might withhold it if she feels it would be more damaging to explain it; however, the answers along the line of 'none of your business' or 'I don't have to' or 'I'm the professional here' would not be inline with trying to minimize damage.

The not seeing your current T while seeing her if you were to see her for talk therapy is pretty common. However, if you were to see her for med management, you should be able to stay with your current T. Some providers won't do med management without therapy. Others will.

Regardless, unless I had no other option, I wouldn't return to her and if she uses any type of electronic medical records that ties into a larger system, I'd contact their medical records and see if you would be able to add a patient note to the visit.

She is a nurse practitioner. Nothing wrong with that and they are knowledgeable but they aren’t doctors or clinical psychologists and they shouldn’t diagnose. I’d see a psychiatrist if you want a diagnosis or at the very least clinical psychologist. In addition, she was rude so I’d not go back

showing signs of psychosis is part of many mental disorders including those you mentioned in your post - depression, personality disorders, being autistic, anxious.

psychosis is not just about having hallucinations. but I notice in your post you stated -

"The closest thing to hallucinations I have are that I sometimes misidentify objects in my peripheral as people or other living things as bugs, but when I go to look at them I can quickly see its just a vaguely person- or bug-shaped object. I also tend to have waking dreams if I get woken up during certain phases of my sleep cycle, but those stop after I've fully woken up."

yes those things now qualify as actually having hallucinations. if you at any point stated this to the therapist or your files stated this about you then yes the moment you lost eye contact and appeared to look disconnected as if seeing something that wasnt really there about objects around you, thats why she diagnosed you with showing psychosis.

psychosis isnt just having a major hallucination or major delusion. its also things like misidentifying real people and objects for things they cant possibly be.

this can happen with just about every mental disorder out there. even what she diagnosed you with - depression. thats why psychosis is now a "specifier" with most mental disorders. the diagnosing treatment provider must state whether or not they have noticed things like blank staring, misidentifying objects and people around them, speech and language problems and more.

my suggestion is not to worry about what your problems are called, instead focus on what the treatment plans are and in time either the problems will clear up or be diagnosed as something different.

It's more like paranoid, reflexive assumptions made instinctively before I've gotten detailed sensory input because the object is not in clear view due to lighting conditions or ocular defects. I'm talking about seeing something like a chair with a blanket draped over the back in the corner of my eye and thinking its a person hunched over, or seeing a dirty spot on the carpet and thinking its a roach. Or like one time I brought my bike into my bedroom and leaned it against a cardboard box and went to sleep. Then woke up in the dark and looked at it without my glasses on so it was all blurry and dark. and still not completely awake yet, I thought it was a bear and I screamed, until the adrenaline fully woke me up and I rationalized that it was physically impossible for a bear to be in my bedroom, at which point I realized what had happened and I felt safe and calmed down, and felt really foolish. But you're saying that is still considered a clinically significant hallucination?

I believe the issue is that my insurance comes through Medicaid (as I am unemployed and have no income) and there are a lot of limits. As she said herself "it's not the best [insurance], but its the best for your situation." I am in a situation where I have to take what I can get.

yes since march 2022 what you are describing is considered having visual /cognitive hallucinations.

as for you asking if what you described is clinically significant....

I cant tell you whether the diagnosing treatment provider and the assessment they did considered what you told them and did was considered clinically significant, only they can do that.

what I can tell you is that...

In diagnostic evaluations, everything the client says and does is taken into consideration as significant (important) along with the special assessment questioning done either orally or written or computerized questionnaires to determine the severity and how it affects the client.

examples of severity in general are things like...

how often it happens?
When does it happen?
is there a pattern?
what does a person do about it when it happens?
how does the person feel about it before during and after the hallucinations?
what are the clients medications, health issues, stressors?

and more.

there is alot that goes into determining severity and using severity scales for assessments. and it all depends upon what the client is saying, doing and so on.

for me with my treatment providers my visual hallucinations are not significant and not related to any of my mental and physical health issues.

my daughter on the other hand our family's treatment providers do consider her hallucinations to be clinically significant due to her scoring on the severity scales, content of the hallucinations, how they affect her life, the cause and so forth.

only you and your treatment providers can determine the severity of your hallucinations on the severity scales and whether they are considered clinically significant and related to your diagnosis. and according to your post they do think its significant and part of your depression diagnosis. otherwise, they wouldn't have diagnosed you with showing signs of psychosis.

if you do not agree with their assessment and diagnosis you will need to take it up with your treatment provider, they can explain how and why you are diagnosed the way you are.

I've been thinking about this post and responses a lot and paying more attention to myself and mental state. After careful consideration I do think I agree that there is some kind of psychosis going on but its not all the time and its not like full blown hallucinations. If anything its more like a distinct lack of mental, emotional experience or awareness when there normally would be. Like it happens in certain situations, or for certain triggers. I think it would be more accurate to say its like a dissociation and maybe there is some other kind of psychosis that goes with it as well.

But now I am afraid to begin any form of treatment that may involve the use of medications. I may be losing my insurance next month because I was able to make a bit of money using Instacart and that could disqualify me from Medicaid, and its not clear if any new insurance I could get would cover continued treatment. I don't want to start taking drugs and then not be able to stay on the regimen because I can't pay for it anymore. That could make things a lot worse. My family is going through a lot of tragic hardship right now and I feel like its going to trigger someone (either myself or someone else) to have a catastrophic mental breakdown.

Sounds like dissociation such as derealization, rather than psychosis. A psychiatrist could confirm that for you. Most likely brought on by depression/stress.


When you've been a member for 6 months, you might become eligible for financial aid offered through MSF. Here's the link for more info:
Community Fund Drive - General Information

Also, check out these other resources for counselling/peer support:

HeyPeers - Where Peers and Support Groups Connect

DBSA - Depression and Bipolar Support Alliance

the dissociation side of things - I cant tell you if the hallucination like issues you are dealing with is dissociation or not.

what I can tell you is that if you read diagnostic manuals like the DSM 5 TR or the ICD 11 you will see that psychosis rules out having dissociative disorders.

I can also tell you that I have a relative who has similar situations as you do and she was diagnosed with schizoaffective personality disorder, then borderline personality disorder, and finally schizophrenia.

my own isssues similar to yours is called normal sleep deprivation issues and medication issues not mental disorder issues, and treatment for me was getting myself on different medications and a regular sleep routine.

solution for my relative was anti- psychotic medication. the same with my daughter.