The night before the session

Dear Doc,

Tomorrow is the first time I’ll be seeing you since our weekend interaction. You apologized for what happened, and asked me to come in to see you yesterday, and I am heartened that you offered to see me without charging me for the session because of what took place. Even so, I wasn’t ready to see you just yet. I needed a day where you were not a prominent part of my thoughts. I was finally feeling at peace, and, in all honesty, I didn’t want to mess it up. 

Sometimes I don’t know how you’re going to be in a session or on the phone. Issues with the insurance company send you into a tailspin, and there are other times when you can be short with me for any number of reasons. 

I still don’t know what I’m going to decide regarding my treatment with you. At this point I feel like I really don’t even want to talk all that much tomorrow. If that comes to pass it might be the shortest session ever. 

Just typing this was mentally exhausting. And, with that, I’m going to bed.

Beatriz

I might be done with you

Dear Doc,

I really don’t know what to do anymore about this therapeutic relationship. I am very tempted to throw in the towel. It’s not because I don’t want to get better, or because I think I’m done with treatment. I’m just not sure that I can continue with you any longer because of some of your own issues that leak into our work together.

You called me yesterday, on a Saturday, while I was having brunch with friends. Thankfully, I did not answer the phone. Later, I listened to your message, and, imagine my surprise when I learned that you called me about a check for which the insurance company stopped payment. How the hell was this my problem? I could tell your voice on the phone was heightened, and it alarmed me. You wanted to know why I had done this when, in fact, I had nothing to do with this issue. In fact, I received something in the mail from them about how they had to reissue you a check from September that was misplaced by you or your assistant. I presume that you must have cashed the “lost” check. But, I really don’t know what happened. All I know is that you called me, and demanded that I call you back right away, and look in to this as soon as possible. How could I possibly look into this issue with the insurance company on a Saturday? And, how and why did you land this problem in my lap? Plus, you should have called your assistant about this, not me. Your voice and approach were fucking shitty. I felt like you were talking to me as if I was some sort of delinquent, which is not fair because I have never had a balance due with you ever. You have issues with money, and I am sick of getting ensnared in your issues with it.

Listen to me very closely. These are the reasons I don’t want to experience your freakdom about money anymore … I took out a huge retirement loan so that I can pay for the neurofeedback sessions that are not covered by insurance. I see you twice a week. That’s $20 a session because those are covered by insurance, unless I have neurofeedback, which is $90. On top of that, I have to drive 27 miles one way to see you. That’s a significant amount of gas I have to work in the budget. Then, on the two days a week I see you, I have to pay to park at work. That’s $15 a day, twice a week. I can’t take the bus from home on those days because I’m coming back from seeing you. I planned on never telling you about the retirement loan because it’s my business, not yours. But you need to fucking understand that I’ve taken great strides to be sure I can pay for my treatment with you.

There are many things in my life I cannot do because of the financial outlay for my treatments. I don’t complain about it because it’s what I have to do in order to get better. However, it is a stress for me, and, from time to time, I do privately lament it.

You also know that poverty and living on the edge of homelessness are part of my childhood history, and you know I get triggered by money situations. YOU KNOW THIS. In spite of this, you still get freaky with me about money, specifically about the insurance company. Oh, yes, and you need to stop asking me to change insurance companies. I am sorry that they nickel and dime you. I really am. But I am not changing companies, and don’t ask me again. This particular company provides worldwide coverage. You know I travel a lot to visit my sister in another state. I’ve had medical issues crop up while visiting my sister, and it would be harder to access services if I switched to the HMO you want me to join. I also think it’s inappropriate for you to ask me to do this.

I’ve been in an intermittent dissociative state ever since I heard your message yesterday. I know you apologized on the phone, but you don’t seem to learn from these situations, and that’s beginning to concern me. I shouldn’t have to worry about shit like this from a clinician. You should be a port in the storm, not part of the storm.

I was doing so well this week. But today felt like the old days where I could not stay in my apartment. I ate every meal out today because I was afraid of what would happen if I remained at home. I felt like I took 10 steps back. Part of me wants to give you my bill for my diner meals today. It was $22 for the day. I would eat a meal, cry in my car for hours, and then go eat the next meal, and then the cycle would start again. I was too scared to go home.

I believe you when you say that this reaction is about something from my past, not so much about what happened with you. True, but I shouldn’t be getting triggering shit from you. You should not be a source for crap like this. You should fucking know better.

I’ve stayed with you because, in spite of your transference issues with me, you’re brilliant when you’re not fucking up. You’ve helped me more than anyone other clinician ever has, and you know I’ve seen quite a few. For the longest time I was just deemed as someone with Complex PTSD with a poor prognosis for full recovery. I was told by a number of professionals that I should just focus on coping instead of a full recovery. But you’ve done a good job of challenging that belief, and you’ve pursued my treatment with the goal of recovery. And we’ve done some exceptional work together, no doubt. Many people comment to me that I’ve come a long way in just the year and a half that I’ve been seeing you, and I agree with that assessment.

I am doing better than I ever have in my life, and I directly attribute that to you.

So, I don’t know that the hell to do next. But, just know this, it’s only because you are so damn good and brilliant that I’m even considering staying with you, though there could be a point where that brilliance will no longer be enough. It could be now, or it could be later. You might want to start learning from these experiences.

Beatriz

The next day

Today I headed out to Doc’s for a very unusual Sunday appointment because of yesterday’s events. I could hardly speak when I arrived, and I thought he just started the neurofeedback right away. Later, I learned that we actually had a bit of a session before neurofeedback, but I don’t recall it.

After the neurofeedback session was done he said this to me, “We need to talk about getting you on some meds.”

My brain just shut down when he said this as this is a rare psychiatrist who is very cautious about meds, and his eternal preference is to try a number of alternatives before turning to meds. In fact, when I originally came to him over a year ago I was on a mega dose of Lexapro, 40mg, with Xanax .25 as a PRN. There had been attempts by other clinicians to add Seroquel, Abilify, and Minipress, but those attempts were met with side effects that made all of those ventures short-lived. With Doc, I eventually got off of Lexapro, and I only have the Xanax as a PRN. I’ve considered this a victory, especially since I attribute part of my weight gain to this massive dose of Lexapro that I was on for 4 years.

But there we were with real talk of meds that I needed to consider. He prescribed Inderal for management of my PTSD symptoms and panic. I didn’t argue since he does not prescribe meds lightly. He also asked me to start taking the homeopathic stuff he recommended to me months ago.

At the end of the session he said this to me, “Honestly, I was frightened for you last night because it was Belle that was speaking to me on the phone. She’s never called me, and that really had me concerned for you.”

I became acutely aware that Doc’s actions yesterday and today kept me out of the hospital. Not only that, but they were far more helpful than any acute psychiatric hospital stay would be for me. The proof is in the pudding in that I was able to go grocery shopping after breakfast for the Thanksgiving pie I have to make on Wednesday night. I was even able to clean out my pantry, and make a simple dinner this evening. It was ass expensive to see him today, and I see my savings dwindling with neurofeedback sessions that insurance does not cover, but I am not complaining. No, sirreee, I am not. I may wind up broke after all of this, but it’s better than dead, and it’s better than completely undone.

Doc asked me to go eat something before I drove the 27 miles back home. He recommended a lovely restaurant in town, and they had this unique dish on the menu called shakshuka, basically baked eggs in a spicy tomato sauce.
eggs

That dish was just what the soul needed. There was also a chocolate croissant at the end of the meal that was unnecessary, but I let myself be indulgent with Letty. She likes sweets, and I still wanted to linger. Last night, I never would have guessed that I would be happily eating baked eggs with english breakfast tea and challah bread a mere 12 hours after I felt like the bottom of my world fell out from under me.