Tag Archives: OCD

When Therapy Doesn’t Work

I’m a firm believer that therapy has helped me a lot. It has helped me understand things about myself I didn’t know before. It has helped me move on and get closure from trauma. It has also been a space for me to be able to express all of my frustrations (without bringing down everyone else in my life). I have learned the so-called “tools” in therapy to help me cope with anxiety and bipolar episodes as well. In fact, I often suggest to people dealing with any issue they find to be overwhelming (not just mental illness) that they see a counselor or therapist to talk about it. Something about talking about our problems out loud helps us understand them better, so overall I think it is a win-win situation.

While all that sounds great (and it is all true), finding a therapist who is a good fit can be challenging. On more than one occasion I’ve found myself in a position where the benefits I was receiving from therapy was being outweighed by negative parts of the experience.

In the past I’ve had issues with the attitudes of therapists, whether that was from being aggressive (which was a turn-off for me), or being too passive (not seeming to care about my issues). I’ve had issues with therapists who had conflicting viewpoints from me (though rarely). I’ve had issues with therapists who didn’t know enough about the issues I was dealing with to provide a well-educated viewpoint.

The one issue I have had with therapists that I consider a hands-down deal-breaker is disorganization.

As someone who lives with Bipolar Disorder, OCD, and Anxiety, there is a certain level of reliability that I require from my health care providers. That includes my primary doctor, my prescribing psychiatrist, and my counselor or therapist. There are times where my condition requires emergency treatment, and I need to be able to rely on my team to get the help I need.

I always feel that I am in a constant state of reminding people that they should expect quality treatment from their doctors, therapists being no exception to the rule. You wouldn’t believe how many people I know who continue to see and pay therapists who do not act respectful to them, who don’t call them back in a timely manner, or who make them feel worse after a session than when they came in. Essentially, this is a situation where you are paying someone to provide support to you… if they aren’t doing that, what is the point?

The difficulty comes in finding the right match, and that many therapists have continued to have paying patients despite providing poor care. If people seeking out therapists aren’t demanding great service, how can we expect to find that great service without creating that demand?

At the same time, I understand that therapists are human. They’re human! Some of them have even gotten into their current field because of their experiences with depression or mental illness in their own lives, which I think is awesome. This is one of the reasons why I think there is a certain level of negotiation you can turn to when it comes to interacting with a therapist.

I’ve been having trouble with my most recent therapist since I began seeing her. I knew part of it was because I liked the one before her so much and we’d worked so well together, so when I reached the point where I was having trouble connecting with her (the new one), we talked about it. Since then I found she was much more attentive and empathetic to what I was saying, which really helped me feel more at ease.

Over the last year and a half, we’ve had ups and downs. For a while she was rarely on time, but began showing an active interest in fixing that, so I let it go.

What I can’t let go, however, was last week’s Lithium emergency. She told me on Tuesday she would contact my (potential) future psychiatrist about a prescription, and then never called me back. She also seemed wildly cavalier about the notion that I would suddenly be unmedicated… which is a big red flag for me. If one of the people on my healthcare team doesn’t care when I am experiencing an emergency, I know I need to shift that position to someone who will. Even giving her the benefit of the doubt (she could have been busy?) I would rather work with someone who has the time to help me.

Six months ago I was worried sick about the prospect of changing therapists, but now I think it is necessary. I am only hoping the clinic will allow me to switch to another person there, instead of having to reach out to other clinics in the area.

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The Long Shot

Yesterday’s adventure (of trying to hunt down an emergency Lithium prescription) started out with an electric jolt to my need to find a solution. It ended with what might be the biggest miracle I’ve experienced since 2014 rang itself in 4 months ago.

Being threatened with only having five days of lithium left (and no refill or psychiatrist to speak of) I kicked it in to high gear yesterday morning.

pleaded with my primary care doctor’s receptionist to land me an appointment at the end of the week (as a last resort) to which she generously complied.

I asked my pharmacy to send a request to my old psychiatrist’s office for another refill, even though I knew that would be a big shot in the dark.

Finally, after running some errands in the sunshine (wasn’t it supposed to rain all day yesterday?) I stepped into the clinic where I see my therapist (and should eventually be seeing a psychiatrist).

My therapist, a contemplative woman who is a great listener and empathizer, is a little lacking in the area of organization. She had no memory of leaving me a voicemail last week that said, “oh yeah, come in Tuesday at three and I’ll write you in for an appointment, only call back if you want to cancel.” Thankfully (considering my frustration around the Lithium issue) she agreed to see me despite never having actually made the appointment.

She told me she was 99% sure that the house psychiatrist would not be willing to refill my medication, something I expected to hear anyway. She told me to try calling my old psychiatrist’s office and pleading with them, something I didn’t feel so great about.

When I asked when I would be able to make an appointment for an intake with the clinic psychiatrist there (I gave them my paperwork a month ago) she said they didn’t make appointments. They just went through whatever people had applied in the order they were received. For that reason, she claimed she could not give me any idea of how long I would be waiting (“at least a month” was all she could say) or any indication of exactly when I would be seeing this phantom psychiatrist.

This sent up some BIG red flags for me. I have never associated my therapist’s personal disorganization with the clinic itself, having seen other therapists there that had no trouble calling me back or being on time or scheduling my appointments, but having to put the faith of my future mental health treatment in the hands of someone who isn’t willing to give me anything more than their word that I’ll eventually see them… well, I don’t operate on a currency made of promises. To me an appointment is an agreement (which exists on paper or in a computer somewhere) on both ends that we will meet, and without that I have nothing.

On top of that, how can I be expected to know how long I need my new Lithium prescription for if I have no idea when I will be able to see the doctor who is supposed to write the next one? That doesn’t make sense.

I walked out of the clinic feeling totally defeated, and in a small fit of hysteria (overlooking the busy freeway) I called my old psychiatrist’s office.

That’s when I’d remembered something I’d been told a few months earlier. An anonymous tipster revealed to me that the psychiatry department of my previous psychiatrist (which did not take any of the insurance plans I was now forced to apply for through the healthcare reform) was considering taking one, JUST ONE, of the plans available. They told me to select that plan, and then call at the end of April to see if the plan would be accepted. I knew this was a huge long shot, but if you remember… I was extremely upset about having to leave my previous (kick ass) psychiatrist. Because of this tip, I had selected the plan in question and yesterday (as April had ended) I found myself in a position to ask their office if something miraculously had changed.

When the receptionist said (what sounded like) yes (I could barely hear over the roar of the traffic) I ran to the nearest building and popped inside to make sure I hadn’t imagined it.

You mean, I thought, not only can I begin seeing my previous psychiatrist again, but he can also then refill my medication in the next couple days?!?

I hadn’t, in my wildest dreams, imagined that scenario would have worked out! It is not very often I have two large, looming problems solved with one phone call, and I thanked the receptionist profusely.

It is so nice to know that these two big issues are now taken care of, and that I don’t have to rely on what seems to be a particularly flaky system to try to receive care. I was extremely upset to have to give up my whole healthcare team when everything changed over with the health care reform, and now (through a couple good tips and a lot of good luck) I am back to having my original healthcare team back.

The trick at this point will be to keep them, because Corey and I will need to move within the next few months. In order for me to keep this insurance and these doctors, I have to remain in King County, something that is another long shot (as housing prices have skyrocketed) but something I also feel more and more compelled to make work since it will be worth the work!

Asking For Help

I’ve been seeing an alarming number of blog posts in which people discredit the notion of asking for help, or claim that asking for help is for the weak.

I find this claim wildly disturbing. Not only has this idea been deterring people across the globe for seeking help for mental health treatment for ages, but it says something that I believe is entirely false.

The truth is that asking for help draws on many traits that are incredibly far from weakness, such as:

Courage

Stepping forward and making your needs known, even just asking a question takes courage. Since when was courage ever synonymous with weakness?

Trick question, it never has been! Courage requires:

Strength 

Something which is the very opposite of weakness!

It is one thing to have courage, but to use it one must have the strength to move forward and take action.

Intelligence

Have you ever heard the phrase, “two heads are better than one?” Asking for help is essentially the intelligent act of asking for two heads to take on a problem instead of just one. Double the heads means double the chances of finding a solution.

Asking for help can be difficult, but overcoming fear shows a display of courage, strength, and intelligence. These traits are not traits of weakness, but traits that most human beings would hope to portray in their lifetime.

I wanted to take a second to also note that asking for help can feel much easier when faced with many options of people to speak with. A parent, friend, or doctor might seem like an obvious choice, but teachers, co-workers, HR department representatives, local crisis phone lines, even sending an email to a blogger (like me) is an option.

If you don’t get the response you are hoping for when asking for help the first time, consider it a practice run! There are other people you can talk to, so don’t give up!

Finding a Primary Care Provider

Recently, more and more health insurance providers are moving toward a system where signing up for care means being assigned a primary care provider (general physician) until you choose to change that physician to someone else.

The trouble is (and I’ve found this on more than one occasion) many of the lists these primary care providers (or PCPs for short) are coming from are outdated. These lists on record often contain the names of physicians that no longer work for the hospitals and clinics found on the list, or they are no longer accepting new patients.

Yesterday I found myself in something of a pickle. My medicaid plan (signed up for near the end of the affordable care act enrollment time) assigned me a sub plan automatically (until I chose another) which also assigned me a primary care doctor that didn’t exist.

What’s worse is that when I tried to fix this (and pick another plan under medicaid) I found out it wouldn’t kick in until May, leaving me a window through April with a wonky plan and no doctor.

Fifteen minutes of tears and a panic attack later, I made an attempt to find a new primary care physician under the plan I was stuck with, only to have the plans’ customer service people assign me a second, non existent doctor. 

The point of this story, to me, is pretty clear. Relying on someone in a cubicle and a phone to choose my doctor for me is ridiculous. Trying to pick a doctor out of a list of names also seems ludicrous, after all… how do I even know which ones are good?

In a blog about mental health, you might be wondering just how important general physicians are anyway… but there are many reasons having a good primary care doctor can work in your favor.

Primary physicians can be the gateway to mental health treatment. I know several people who are prescribed mental health medications by a primary physician (though I’ve had terrible luck with that myself). On top of that, many insurance plans require a primary physician to refer (basically give you an “in” and a stamp of approval for mental health treatment to your insurance provider) you to mental health specialists before you can get treatment.

Primary physicians are often a gateway to all realms of physical health. If your insurance doesn’t require a referral for mental health services, it is much more common to require referrals to all other specialists, including anything from dermatology to neurology to allergy specialists. Doing what we can to help our minds is only half the battle, we need to be able to take care of our bodies as well. This might even include a primary physician helping counteract physical side effects of psychiatric medications, something that has been super important in my own search for better health!

Yes, these people are important, but when being assigned phantom PCPs, how do we find good doctors accepting new clients who also take my insurance??

My advice is not to start too small. Start by looking for locations that generally accept your insurance. You can do this by doing a search online at your insurance provider’s website (usually, you might have to google the addresses you find to see the actual locations), or you can call your insurance customer service line (though I’m warning you, this can be a huge headache). Something that worked for me was calling the office of my phantom PCP (via a number on my new insurance card) and finding out there were several (real) doctors there that do take my insurance.

I find that if you need to choose between calling insurance people or calling clinics, you will often get much more help from the clinic receptionists. As long as you try to remain calm and friendly, they can usually point you in the right direction.

We have several hospital systems in Seattle, so finding out what hospital system takes the health insurance in question can also help you find primary care doctors and specialists in your area. I called my usual hospital (who didn’t take my new insurance) but found out another hospital down the road who does. 

Don’t underestimate the knowledge of friends, family, or co-workers who have the same insurance as you. If you know someone on your plan who claims they have a great doctor, ask for their information! This rings true for not only primary care doctors, but psychiatrists, therapists, and any other specialist you might be interested in seeing.

Once you’ve found out if a location (or if doctors at a given location) take your insurance, you can call and ask the receptionist if anyone is accepting new clients. I’ve met some really wonderful receptionists who have even gone so far as to give me brief descriptions of the available doctors dispositions!

Writing down the name of the doctor (with correct spelling), the phone number of the location, and the address is important. Once you have this information, you can go back to the insurance website or customer service line and request a change of primary care physician.

This last step is IMPORTANT, because if you don’t follow through with the choice that you’ve made your insurance company can potentially deny your claim (aka not pay for it) if the doctor you see doesn’t match the doctor listed in their database.

Some insurance companies will allow you to change this information on their website, while others have an automated phone system. On occasion you might need to speak to a customer service representative (who may also put you on hold to call the clinic you just talked to and verify the information). In any case, once you have finished the process you can expect to receive a new ID card in the mail with your new (and correct) PCP information listed.

I realize this is a lot of information, and I know nobody likes insurance nonsense, but finding and selecting a primary care physician before attempting to interact with insurance representatives can save you a lot of hassle. I know it would have saved me a panic attack, and three hours of yesterday’s morning!

Journalist Comes Out About Having Mental Illness

I want to share an article that I found interesting, it is a post written by Mark Joyella, a journalist and former television reporter who has just recently come out about having a mental illness to help fight the stigma that surrounds it.

His article, Screw Stigma. I’m Coming Out takes us on a journey through his fear of being identified as a mental health consumer to a place where he feels comfortable sharing his OCD diagnosis.

For someone in the public eye, I found this article to be extremely thoughtful and well written, as well as reflective. I think his journey can be related to anyone who has questioned their own diagnosis or felt self conscious about the idea of having a mental illness, not just for folks who have an OCD diagnosis.

In any case, I suggest checking it out… and for Mark Joyella, a big high five – thank you for being brave enough to come forward about your experiences!

One Week of Open Enrollment Remaining

These times, they are a’ changin’. I’m sure you’ve probably seen the buzz around wordpress regarding enrollment in health plans through the affordable healthcare act (though probably more widely known as “Obamacare”). Since only a week remains in the open enrollment period (the time in which you can sign up without being docked the tax penalty for being uninsured) you might find yourself scrambling to figure out what exactly you need to do next.

Be prepared for change.

I know many people (like myself) who have needed help with the cost of mental healthcare while uninsured and have gone to places like charities, local hospitals with financial aid programs, sliding scale clinics, and patient assistance programs through medication manufacturers. I knew that the affordable care act would impact these services, but (as I found out quite abruptly this month) most of them are dissolving in lieu of being replaced by low-cost state medicaid plans.

That means signing up for insurance by March 31st!

What this also means is that the insurance you qualify for or can afford might not include the doctors you have previously been seeing. Personally, I am having to start over again from scratch… which isn’t a good feeling, mind you, but the alternative is to not have any insurance at all and go further into debt.

I put up a big fuss about it the last couple weeks because it is hard to leave a team of healthcare professionals you trust. I know, I am in the same boat. Unfortunately, as I mentioned, everything is changing. I’ve talked to several doctors who intend to begin adding more plans they will accept in the future, so there is still hope of things evening out a bit more, but in the meantime we are living on the healthcare frontier. Rope and hogtie whatever doctors you can get your hands on at this point!

Consider all your options.

Can you afford to get coverage through a private insurer? Can you get insurance through your job if you qualify? Can you get insurance through your family? Can you get insurance through a partner? I’d be lying if I said I didn’t momentarily consider the notion of getting married for the sake of Corey’s benefits… but realistically I don’t think the situation is quite that dire.

All I’m saying here is that there might be a way to lump coverages together, and you might find that is a better option for you than spending money on a plan that may not cover the things you need covered.

Talk to your doctors.

If you’re planning on signing up before March 31st I strongly suggest you give your primary doctor, your specialists (including your psychiatrist), and anyone else (like a therapist) a call and ask what insurance plans they will be accepting. In some situations, it might be easier to ask which plans they aren’t accepting, as that list might be shorter.

You may even want to tell your doctor your current situation, as I’ve had doctors who had professional friends in other hospitals and clinics around town they could suggest to me (at places that would take my new insurance).

If keeping your current team is important to you, find out what insurance providers they work with and see if you can afford (or if you qualify) for one of those plans.

See what you qualify for.

This is the government website that will link you to each state’s official marketplace website. Going to your state’s website and creating an account will allow you to use your personal information and financial information to see what insurance providers you qualify for.

There are some issues with the system you might want to be aware of before moving forward (at least, issues I had with the Washington State Healthcare site).

First, the site doesn’t allow you to see all of the options, only the options you qualify for. I like to give myself a little wiggle room, a window of what I would feel comfortable paying, if you will. This website did not allow for that kind of search, and (to make matters worse), once I submitted my information I was automatically sent to a page that said, “great! you signed up! We’re sending you a coverage card in the mail!”

The website didn’t ask me if I wanted to sign up. I simply was signed up when my search only returned one possible match to the parameters I entered.

Honestly, I was a little pissed off. I mean, at least give me the illusion that I am entering into this by choice!

Anyway, I don’t know what happens if you qualify for several plans, but I imagine in that situation they give you a choice. That would make sense (fingers crossed) anyway.

Pick a plan.

Another problem I had with this system is that it can be difficult to find any in-depth information on what any given plan covers. Why would I pick a plan when I don’t know if it covers what I need? Obviously I want to choose the plan that is best for me and my own situation.

I think at the very least, these plans will show you the monthly cost, as well as the deductible for the plan. It is important to note that a deductible is the amount you have to pay BEFORE the insurance begins paying for your healthcare. For people like me (who have a lot of expensive doctor’s visits) you want the smallest deductible possible.

Sometimes doctor’s visits and medications don’t count toward the deductible (depending on the plan) but keep in mind that if you need lab work for lithium labs or any other blood screening this often falls in the category of pay the deductible amount before insurance will chip in.

On top of this, if you’re able to, I would do a little research to see the situation as far as their coverage specifically for mental healthcare. How many therapy visits are covered in a year? What percentage of inpatient hospitalization is covered? Does this plan require referrals (your primary doctor authorizing your need for mental healthcare)?

This research step is one area I really hope will be improved upon in the coming years for this system, as I am a big believer in not paying for a service that hasn’t disclosed to me how it works or what my coverage is. Unfortunately, I’ve had a very difficult time receiving answers about coverage, and if possible, try calling the insurance companies themselves. That’s who I’ve had the best luck getting through to.

Once you choose the plan best suited (hopefully) for you, you’re done! Of course, you can’t really begin setting up your new health care team until you get the paperwork in the mail with your insurance card and ID number. Remember, each plan is different, and some will require you call them before being authorized for mental health care, while others will require your primary care doctor to do it for you.

If in doubt, be prepared for higher cost services and fewer financial aid resources.

Ok, so let’s say you’ve read all this and feel appalled. Horrified. Maybe you’re stubborn (like me), or maybe you don’t like being forced into things (um, also like me!). What happens if you don’t sign up?

Well, for starters there is a fee taken out of your tax return, that’s 1% of your income for individuals who make over $10,150 per year, or $95 per person, per year (whichever is higher). You are exempt from paying this fee if you do not earn enough to file taxes (there are a few other exemptions you can check out here).

Realistically, as I have pretty much zero income I wouldn’t have to pay the fee, however the other consequence of being uninsured is that you are responsible for paying 100% of your healthcare costs. As I mentioned earlier, the programs that were in place to help people who couldn’t afford care are rapidly disintegrating, and for those that need regular care (like mental health care, for example) these bills can quickly add up and lead to all kind of exciting debt, possibly even bankruptcy. 

Have you ever had collections agents calling you five times a day to try to collect on medical bills? They are there all day, every day, reminding you of what you owe until you go completely mad. Trust me. It isn’t a life I want to relive, that that’s why, despite all the funky, backwards scrambling that is going on right now in regard to healthcare, I would rather be covered than not.

For more in-depth information on the consequences of not signing up for healthcare, you can visit the Government’s page about it. 

OC87; A Personal Story of Mental Illness

Do you ever find yourself thinking, “man, my life would make a good reality tv show (or) documentary, wouldn’t it be great if people could look at what living with mental illness is actually like?”

I have, admittedly, and I sometimes fantasize about being followed around by cameras when I’m bursting into tears for no reason at the grocery store or attempting to convince doctors or other health providers to see me for free. Does the general population understand what many of us go through to try to receive care or improve our situations with these various disorders?

I think the answer is decidedly, “no”.

Well, this is apparently a pretty widespread idea, and a man named Bud Clayman is the focus of a new documentary called “OC87: The Obsessive Compulsive, Major Depression, Bipolar, Asperger’s Movie.”

I know I mentioned OC87 in passing last week, but I wanted to take a bit of a closer look at it.

The film, currently open in New York (but said to be soon opening more widely across the country) follows 51 year old Clayman for two years as he receives treatment for Obsessive Compulsive Disorder, and actually is diagnosed for the first time (over the course of filming) with Asberger’s Syndrome as well.

The LA Times article says that Clayman first wrote an essay about how therapy has helped him, then decided to make a documentary about it.

So far OC87 has gotten some great reviews, so if it comes to Seattle I know I would definitely be interested in checking it out. I think I am curious, more than anything, about how someone would present these sorts of behavioral issues on film.

As far as the trailer goes, I was really impressed with it. I would definitely suggest checking it out if you haven’t yet!

For more on OC87 you can read more in the LA Times here, as well as check out the trailer here!