Tag Archives: therapy

Can’t Stop a Moving Train

About a year and a half ago a bipolar mixed episode with psychosis and delusions wreaked havoc on my career in the fashion industry. My paranoia spread through the company until it got a grasp on the HR department and sent everyone reeling and investigating one another. It wasn’t until I pulled myself from work (for fear of hurting myself or someone else) and spent over a month in depression before I could see the delusions for what they had really been.

At the time I was extremely frustrated. This sort of thing has happened to me fairly regularly while working, I’ve never been able to hold a job for much longer than a year. My entire healthcare team (my psychiatrist, therapist, etc.) suggested I stop working because the stress of it was potentially triggering episodes far worse than I would normally experience.

I remember falling into this daydream-like state, wondering if I could eliminate all stress from my life (and primarily stress due to working) if things would quiet down. If the episodes would minimize, and I could have a stable-ish (albeit slightly boring) life by simply doing nothing at all.

Seems like a simple enough theory, doesn’t it? Remove all triggers and there is no reason for an episode to happen. I don’t know why I believed a move like this would work; I had seen plenty of people on SSDI at support groups who seemed totally out of control all the time (and they weren’t working either!).

My therapist at the time seemed to believe this would “work” (lessen my general episodes) because she, unlike me, believed all episodes had to be triggered by something. I tried to explain to her that wasn’t how it worked, and that episodes of bipolar disorder often seem to come and go as they please, but we were both too hopeful to pay much mind.

A few months ago I was sitting with her, now over a year since we put this plan into action. It was right around the time after my hearing (February) where I was significantly depressed. After all of the time I had put into applying and waiting for an SSDI decision I sat down in front of her and she said to me,

“You know what I think would help you? Working.”

Completely exasperated, I slapped my hand to my forehead and sighed. We had come full circle. Needless to say, my desire to get a new therapist (I start with someone new tomorrow) had been growing for quite some time.

As it turns out, you can’t just wave your hands and expect to stop a moving train. True, going without working is generally one of the things I attribute to not having been hospitalized lately, but it has honestly (at times) been just as stressful as working would be (with a much lower income).

Last week I managed two or three days of stability in a row, and I found myself thinking how great it would be to start working again, to meet new people, to have a task, and to have a little (as opposed to no) money. I’ve been here before though, I know this charade. I know that when I feel stable I generally feel like I can take on the world without any problems, and the truth of what happens when I do gets pushed to the background.

To top it off, even if I wanted to work (I say “work” but realistically mean roughly 10 hours a week) right now, there are some significant roadblocks. Some, like my social security disability application, I put there myself. I still haven’t received an answer after my hearing in front of the judge in February. My attorney has suggested that working (even 5 hours a week) will often return a negative reply from the government, because working 5 hours a week (and I kid you not) somehow suggests I could potentially work 40.

You can believe that if I could work 40 hours a week without becoming totally delusional, homicidal, and suicidal I would be doing it. I have always been an overachiever, and I’ve had several good positions at some very noteworthy companies (making sometimes incredible amounts of money). Why would I ever stop if I could handle it? Why would I ever give that up to sit in the dark alone, teaching myself to make a proper cream sauce for lack of anything better to do?

Honestly, I also found it a bit of a slap in the face when I met with my social security judge and the “vocational expert” for my hearing suggested I become a hotel maid, or a bottle-capper, or a mail-room clerk (because those jobs couldn’t possibly exacerbate bipolar disorder!). It felt rather humiliating that these “experts” were so quick to throw out the degree that I earned (and am still paying for) and my intelligence or goals or interests, simply because I have a mental illness. My attorney assured them that no matter what job, I am not capable of maintaining it (in my current, still unstable state) which I appreciated, though I still left feeling sour.

The other roadblock is the train itself. I am still looking for ways to help reduce my symptoms of bipolar disorder, and without some kind of useful treatment I am likely to become very volatile very quickly in the workplace. I like to believe (especially when I am feeling good or stable) that I am in control. After 10+ years under that delusion, I understand that there is a lot more to it. It appears that the more stress I experience, the less control I seem to have over myself. While I have been working hard to combat this truth with practically anything I can find, I am still doing so in an environment with the least amount of stress possible.

I’ve had a lot running through my mind. Frankly, I don’t know exactly where I am going to go next, and there are still many things up in the air (my SSDI decision, what my attorney will suggest to do next if it is a “no”, etc.). Right now I am putting all my attention on moving, because if there is one thing I want to get right… that one is it.

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Improving Mental Healthcare Access for Veterans

Happy Memorial Day folks!

I wanted to take some time to bring a little awareness regarding an issue that I consider extremely important right now, and that is the long wait times and limited access Veterans have for receiving mental healthcare.

As someone who lives with bipolar disorder in the pacific northwest, I have seen (and experienced) huge wait periods between when myself or my peers have needed to see a specialist and when we’ve actually been able to see one. Unfortunately, this is something I’ve rather come to expect these days.

What I don’t expect is similar wait times for veterans. While I’m not here to say that veterans are somehow better than the regular population (in fact, I generally consider myself anti-war) but these are people who have already given up an extraordinary amount for the sake of the rest of us.

As someone who has been in the position where long wait periods for psychiatrists left me with no other choice than to enter a psychiatric hospitalization I understand how hopeless this situation can feel, and I hope our government can take action on getting these folks the help that (I dare say) they’ve earned.

You can find an article with a little more detail about the situation here.

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.

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!

The Well is (Abruptly) Running Dry

You might remember that in my last post I mentioned that I had six months of refills on my medications, so it wasn’t a huge deal that I couldn’t get in to see a psychiatrist right away.

Oops!

Apparently I, having no concept of time whatsoever, didn’t realize I’ve filled all those. The bottle I had put half of this month’s Lithium in for my trip to Florida was old, and the promised number of refills available on the label isn’t actually true.

So now I’m in a position that I’ve chastised others for being in. I have five days worth of Lithium left, and then…

…well, I don’t even want to think about what comes next. I’ve experienced extreme withdrawal symptoms from having my medications stopped abruptly before, and I am terrified of the consequences. (The ironic part is that the withdrawal symptoms I had were so traumatic that it kept me from wanting to be medicated for eight years, I never wanted to be put in that position again.)

My options seem as thus:

1. Attempt to refill the prescription as normal and request my pharmacy ask my (old) psychiatrist for another prescription. (Done.) This is a real long shot, but my old psychiatrist has shown pretty much nothing but mercy for me up to this point. Maybe he’ll set me up with one little month’s worth? I understand his hands might be tied on this, but I figure there is no harm in trying.

2. Express to my therapist the direness of the situation and see if she can pull some strings to get me a replacement prescription prior to my intake with their psychiatrist. (I’ll take care of that in a few hours.) I realize this too is a long shot, but since I am in a precarious position I don’t have any qualms about trying anything and everything to try and get this figured out before my time runs out.

3. Make an appointment with my primary care provider (hopefully before my time runs out) and request a month’s prescription to last me until I can (hopefully) see my new psychiatrist. My PCP has had a lot of qualms about the notion of prescribing psychiatric medications (something I respect but can also put me in a bit of a pickle) and to top it off, he is one of the most popular doctors at the hospital I go to for care (so he usually is booked a week out in advance). I think the best route to take here is to try to make an appointment near the end of the week, and then cancel it if plans 1 or 2 should happen to work.

4. My only other option is to cut back. I take 1200 mg a day (four capsules) and if I immediately cut down to three capsules a day I could give myself one, maybe two extra days to scramble and figure things out. This is obviously my last choice of my options, but again, I am terrified at the notion of having to jump from 1200 mg to zero mg. I feel fairly confident that I can get one of options 1-3 to work so I am not going to immediately titrate down, so lets hope I get lucky somewhere down the line this week.

Frankly I’m a little upset at myself for not having caught this sooner (but I’ve been out of town, so really how could I?).

I find that I get confused most easily by medications that require me to take multiple tablets or capsules per day, because when I look in the bottle it always looks like there are a lot in there. Realistically, even if there are 20 pills of Lithium in there, that is only 5 days worth of medication.

Like I said, I feel pretty confident that one of these plans will work in my favor… but you’d better believe I am going to make a big fuss when I get into my local clinic to see my therapist today about needed to see the house psychiatrist as soon as possible. Way to light a fire under my ass, Lithium!

In Psychiatry Limbo

May first has come and gone, and I am now covered under my (selected but previously withheld) insurance provider under my state Medicaid program.

It has been two months since my last visit to my psychiatrist, and now that I have this new, shiny insurance I can potentially begin to see one (but not the same one) again. I made about 15 unnecessary phone calls to my insurance folks and psych providers in my area before deducing that the simplest route will probably be for me to see the psychiatrist who works at my current therapist’s office.

Despite making this decision, there are a lot of questions swirling in my head about how this is going to work. My previous psychiatrist was linked to a hospital, so getting lab work done (to track my lithium levels or other side effects) was extremely simple. Seeing a psychiatrist in a building above a Mexican restaurant leaves me thinking things probably wont be so straightforward anymore… and I am eager to meet him to find out exactly what that will mean for my care and time management.

Realistically, at this point I am pretty well off. My old psychiatrist wrote me a prescription for six months worth of medications, so I am in no way hurting in that department. My eagerness to meet this new doctor is really just coming from my own impatience and curiosity about what kind of man he is, and what he can bring to the table for me. 

I was a little disappointed to find that my last visit to the clinic did not result in making an appointment with this psychiatrist. New insurance means I had to do the intake paperwork all over again, and my only option was to check a box suggesting I am interested in seeing someone for medication management. I’m finding I’m a little nervous, because  my last doctor had a six week waiting list before I could do an intake with him. If I haven’t even had a chance to make an appointment with this person, how much time is going to be tacked on to that inevitably lengthy wait?

I feel I must add that for most people in most areas throughout the country, the wait time probably isn’t as high. The big trouble is that here, in Seattle, there is a huge demand for psychiatry and only a few good doctors in the area to meet that demand. Now that the healthcare reform has made these doctors draw lines in the sand about what patients they will and will not take, the ones who accept the lowest (and most common) form of insurance (state Medicaid) are totally swamped.

Again, I know I can wait. I know I can be patient about this… I’m not exactly looking to rush into trying any new medications in the next few weeks (as I’m taking a break from all that). I just feel uneasy not having a psychiatrist at my beck and call, because things can change for me from tolerable to intolerable (to say the least) for me with the blink of an eye.

I’m heading to the clinic tomorrow, and hopefully I will be allowed to make an appointment. Just having a solid date, somewhere out in the future, floating around (even if I can’t touch it) makes me feel more at ease with the whole idea of being in psychiatry limbo.

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!