I am starting to get really apprehensive now. It is only two weeks until my current Psychiatrist leaves. I have been with him for ten years ! That is a long time to build up trust in someone. He knows my whole story and history. Understands all the medications I have tried and worked/failed. I am absolutely dreading the handover. It is causing me enormous anxiety and worry.
How do I build up such a relationship with a new Psychiatrist? It took me such a long time before. Admittedly I was a lot sicker and more unwell but nonetheless having to start from scratch is agonising. I do not want to have to go over my story with a stranger again. I know they will have a good ‘handover I trust my current Psychiatrist to do that. It’s just how will the first session go? How will I get myself in the door of his clinic? I was referred to him my current Psychiatrist so I am placing a lot of faith in him – too much maybe but how else do you go about choosing one. Word of mouth. Well that’s fraught with fire and brimstone that’s for sure and potholes aplenty because what works for Billy definitely doesn’t work for Jack. Psychiatric conditions vary widely and presentations even wider so what works for one patient can be disastrous for another. The truth of the matter is it is trial and error and you have to be discerning and assertive and if a Psychiatrist is not working for you LEAVE and find another one. Remember you are paying the bill. There is no shame in not going back if they are doing you no good, in fact maybe doing you harm and triggering your condition.
So what do I want from the first appointment?
Firstly I have to remember it’s not a conversation, and it’s not a debate. He is either treating my symptoms with medication or guiding me to “treat” my own symptoms. Neither requires much talking.
If the psychiatrist says more words than the patient, then the psychiatrist is the patient.
Many psychiatrists talk because they feel powerless. I as the patient am the one in distress. How can the session be worth the money unless I get something? A prescription is good, but what else—what now? So the psychiatrist thinks they need to say something, to appear as though they are giving something to the patient. The worse the situation is, the more the psychiatrist is going to talk. Is that how it’s going to play out. That will drive me made. They’re talking to make themselves feel better, to justify their value as a psychiatrist. He better not do this. It’s not going to help us get off to a good start. There I am catastrophising again. Complex PTSD ratchetting to an off the scale radar.
I want him to empathize, not sympathize. I cringe whenever I see a psychiatrist try to sound genuine while they affect a sad and shocked voice, lean forward, grab a box of tissues, “Oh my God, I’m so sorry, that’s terrible!” It’s fake, which makes it annoying, but it’s patronizing, which makes it countertherapeutic. A psychiatrist cannot sympathize—did the same thing happen to you?. What they need to do is empathize, to understand the feelings, to appreciate them—not to share them. Plus, they don’t know what the situation means to me. Maybe I am secretly happy (and guilty about it), and now that he has confirmed that it’s “terrible,” I’ll never admit to him or myself I am happy about it. Simply saying, “I’m sorry. Can you tell me more about…” is all that’s necessary.
And enough with the tissues. If he stalled the interview to go get me a box of tissues, he will have failed, he will have changed the energy of a key moment. And won’t do this—let’s be honest—not because I needed tissues, but because it will take some pressure off the moment and allowed him to give me something. I never understand why they don’t just leave tissues by the patient chair from the beginning and focus on what his doing.
So what I want him to say is simply this “Where would you like to begin?” And then to shut up.
Also, I don’t want him to interfere with my treatment with my Psychotherapist. She is my godsend and has got me through the last four years intact. I have made many attempts at suicide and repeatedly self-harm and she has non-judgementally supported me through all this. The medications are absolutely necessary hence needing a Psychiatrist but the EMDR and Psychotherapy that I do in conjunction with the medications is what is going to get me through this maze of Complex PTSD and Dissociative Identity Disorder, Anxiety and comorbid conditions. She is my rock. My current Psychiatrist works well with her and they correspond weekly by email and manage inpatient admissions in times of crisis. I am hoping he will be willing to do the same and not let his ego get in the way. He has placed one call already to her which she could not take but things are looking good on that front.
Let’s face at the crux of this crisis is the issue of abandonment. I feel abandoned by my Psychiatrist. I have been abandoned as a child repeatedly by my family, friends, caregivers and in my eyes other professionals. It is hard for me to rationalise that this is a career move for him. On a logical level I know it is but on another level, I just feel plain abandoned yet again. All the old doubts and feelings come rushing back and my confidence is shattered and over the last eight nights we have ended up in the Emergency Department with self-harm episodes requiring stitches due to flashbacks brought on by the stress of the upcoming change. My husband has been very supportive and not judged me for the cutting understanding the insecurity I am feeling. He is doing everything he can to keep me safe. My Dissociative Identity Disorder is out of control and the alters are running the show which is partially attributable for the cutting as I blame myself for the Psychiatrist leaving as everyone always leaves me. It’s a nasty spiral.
I meet the new guy on June 27th so hopefully meeting him will allay my fears and we will develop a good working relationship. In the meantime, I need to work with the family to stay safe and continue seeing my Psychotherapist. I have my last meeting with my Psychiatrist this Wednesday. I have bought him a copy of Seamus Heaney’s Poems as he is an avid fan. Something we often used to discuss. I’ll miss our discussions. We both had a love of literature. For a Bulgarian he understood the Irish psyche very well !!!!!! We had a mutual understanding. Wish me luck.