When the Therapist Just Doesn't Understand

Last week, I met Mel, the crisis counselor from the 10th level of the Nether Regions. Short version: a medication dosing error combined with hormones put me in the Crisis Intervention Unit. Mel's job was to talk to me--and I learned that sometimes counselors just don't get it. She nearly reduced me to tears and I seriously considered asking her to stop talking to me. I left feeling worse than when I went in.

Mental Illness vs. Asthma

Mel told me that she was asthmatic and took medication to control it. Since medication compliance controlled her asthma, medication compliance should control my mental illness.

It would be nice if it worked that way.

What Mel apparently doesn't know is that psychotropic therapy, a.k.a. medication, is as much art as science. There's a lot of guesswork that goes into the decision process, and that results in a trial and error approach to medicating a person with severe mental illness. One man's meat is another man's poison. In addition to this, sometimes medication stops working and the process starts all over again.

I should have said this to Mel. Sometimes a simple explanation of the facts is all it takes to get someone who doesn't understand to get it.

Know Your Case

Mel told me "The hospital is not therapeutic". In some ways I agree and in some ways I disagree. Hospitals are not a long-term solution. But they are great for stabilizing someone who is in a short-term crisis, and that is therapeutic. They are also excellent places to get any difficulties with medication ironed out. That, too, is therapeutic.

Once again, I should have said that. Knowing what standard treatment is for someone with your mental health diagnosis can be helpful, because then you know what to ask for. Also, knowing your current mental state and what standard treatment is for that can be useful, because you know what you need.

It's easier said than done. But it's an invaluable skill for your treatment.

Talking about what you need is the only way to get it. It's not always easy--I had one psychiatrist refuse to write a note authorizing addiction treatment--but be persistent. Fight for what you need until you get it. Sometimes that's the only way to do so.

When There Absolutely, Positively is No Hope

My mother has a way with words. She had this to say about Mel--"She shouldn't be in crisis counseling. She is a crisis!"

Sometimes there is absolutely, positively no way in all Creation to make a person get it. What you do from there is your choice.

Because people with borderline personality disorder (BPD) are prone to switching therapists at the first sign of difficulty, I'm not going to recommend finding a new therapist except in extreme cases (for example, I fired a psychiatrist for telling me it was my fault I was raped). Give it a chance. Maybe agree to disagree. Most therapists won't take it personally if you disagree with them. Do what you can to stay in therapy.

But when it comes to your care, don't accept any less than what you need. Argue your case. Tell them why you feel you need what you believe you need. Tell them what standard treatment is and argue why you feel that's what would best help you.

Sometimes, however, there is absolutely no way to make the therapist get it. In cases like this, you have to decide what you want to do. Ask yourself "How important is it that this person understand?" Respond accordingly. If it's something minor, let it go. If it's something major, decide whether or not you want to continue with someone who doesn't get it.

Your treatment is ultimately in your hands.