How do you know when you are done with therapy?

I am "lucky" enough to not have an insurance company making this decision for me- but only because I am seeing a therapist who does not take insurance. I am paying out of pocket, until I meet my high out of network deductible, and then will hopefully get reimbursed a little bit.

Last week I went to my therapist appointment- and had this feeling that I wasn't sure I needed to be there. I haven't had that feeling in a long time.

Usually when I quit therapy it is because I move (if it is a good therapist, but that is rare)- usually I quit because it is not helpful, and I don't think my therapist is very good. And usually that has been the case because I have tried to use "in-network" therapists, and it just never has worked out very well. So much of the past 9 years that I have been working I have only been in short periods of therapy, and then quit. I have had some extraordinarily bad ones!

This time I went out of network, and it was worth it. I like her, and she has been helpful. But how much longer? Is it therapy forever?

I think that a part of me is afraid to stop, because I am doing well, for the first time in years. I don't want to rock the boat. If I am not stopping my meds- if meds are forever- why not therapy? But I don't think that therapy is forever, at least for me. Unfortunately I do think that meds are forever for me- but not necessarily for everyone.

Maybe it is time to go down to every other week.

Maybe I quit therapy too soon?

I've been going through a tremendously bad time the past few days. I can't seem to get my equilibrium back, even though I'm back on my BC pill.

I have learned over the years not to call my mother wanting sympathy or understanding. It's not that she doesn't mean well, it is just that she doesn't understand at all (but thinks that she does), and that she is so needy herself.

So today she called to tell me about all of her problems and the ongoing problems of everyone living in her household (Grandma's house) - now up to 5!. She needs someone to talk to, and I can't always deal with it. I was particularly unsympathetic today, and cut the conversation short. I think she needs a therapist.

When I think about the last time that I saw my therapist, it was weird. I wasn't even sure that I wanted to quit therapy. Maybe I thought I'd reduce the frequency, or change the forcus, or something. I went in and said that I was re-thinking therapy. Thinking that we would talk about it. But which she took as me saying that I was quitting- she asked me why- I told her that the past two sessions I really had not felt like I had anything I needed to say, and that I wanted to focus on studying. And then she thanked me for coming in to tell her, and told me that she wouldn't charge me for today- and asked her if there was anything she had done or said wrong,etc.

So it is a strange situation.

I did something so strange today- I accidentally took my nighttime meds in the AM. So I went to work on 5mg of Zyprexa. Not fun. Fortunately, no sleeping pill in the mix- not that it has been working too well. I did manage to make it through the day, but it was a struggle. But maybe it helped me to be more mellow. No tears today. And then I came home and napped. Maybe, though, this double dose of Zyprexa is just what I needed to get me out of whatever I have gotten into these past few days. I do feel less crazy today. But it is not something I want to repeat.

I have definitely wanted someone to complain to the past few days- just like my mom. But then to talk about a work issue too. Is it better to be though crazy, lazy, or incompetent? I mean, being mentally ill is not an excuse for not getting your work done- you are still responsible for it, and you can still get fired if you don't do your job. But at the same time, it is an explanation. I tried going in this past weekend, I got myself there, I just couldn't keep myself together- I was feeling too crazy. And perhaps that truth is better than people thinking that I just don't care. Or maybe not.

Rethinking therapy, again

I was in therapy a bit as a child and as a teenager, for all the good it did me. Not all of the time, but at times. And then, from my sophomore year in college on I was in therapy most of the time until my early thirties. I didn't always find it useful, but I felt like I was "doing something," and trying to get better. With the majority of therapists, I would give them a few months, maybe a school year, and then move on, having not felt like I was getting much from them. But then there were a few who were good and useful, and I stayed with them until I moved, etc.

I often took the summers off, or quit when things were so bad that I know I wasn't going to be able to get myself to my appointments regularly and didn't want to get charged. At least with a psychiatrist, you come out of the appointment with something tangible, a prescription in hand. But getting to a therapist on a regular basis when severely depressed and can't get get off the couch, much less out the door- that is sometimes asking too much.

Once I started working again and was no longer on disability, I no longer had Medicare/Medicaid, and I no longer felt like I should ask my parents to help pay. So for a while I tried finding therapists "in-network" with my new private insurance. And I have generally been disappointed. I didn't put up with them for very long. And for the most part, I have not been in therapy.

But since I have moved to where I am now, I have been pretty socially isolated, and decided to give therapy another try. After trying an "in-network" therapist twice, I agreed to let my parents help me to pay privately for someone. Yes, I have out of network benefits, but the out of network deductible is so high that I might as well not.

And I like her. She has been providing what I need at the moment- which is social support, someone to tell my story of my crazy history to- which is something I seem to feel the need to do periodically, and some good ideas about being in the moment. She was my sounding board during my year of seriously questioning meds for the first time.. She is really a DBT therapist, but I had a bad experience with DBT in the past, so she is not pushing it too much.

I have had every kind of therapy there is: psychoanaysis, CBT, DBT, you name it. I feel like I really shouldn't need therapy anymore. I don't believe in therapy forever. And it seems pretty pathetic that at the moment I am really just paying her to be a sympathetic ear and give helpful suggestions and feedback.

It is rare that I find a therapist I really like. I think she is maybe number 4. And yet, there is a part of me that feels like, if I am in therapy, it means I am dependent, defective, not a grown-up. Somehow, it bothers me even more to rely on a person than on a pill.

I think I'm quitting therapy

I found myself dreading my therapy session tomorrow. Because I didn't want to admit that I haven't done much studying. Because I didn't want to admit that I went back up to 5mg of Zyprexa, at least for the moment. I just don't want to have to explain myself to anyone, if I don't want to.

And I know what I am doing with meds for the next month or so- nothing! No changes. I have come down some already, I will just try to maintain that. At my next vacation, I will reduce something a little bit more. But this is going to be a very, very long process. And I suspect I won't be able to get off of everything.

And I think I also did in therapy what I have to periodically do- which is to tell my story of my crazy past. OK, so now what? She's not the person to discuss my concerns about meds with. I don't want to do DBT. Now that I have found a support group, even if I do not get myself there every week, just knowing it is there- I feel like I am less in need of just a supportive relationship.

I don't believe in therapy forever, at least not for me. And I have certainly had a lot of therapy. It is time to stop. I know what I need to do to make my life better. Whether I do it or not- it is up to me.

Plus, I won't have to be taking money from my parents for therapy.

Am I wrong about this? It is not often that I find a therapist who I like, and who has been useful. Most of them are really bad. Do I want to give this up before I am sure it isn't going to help anymore, especially when I am getting help paying for it? And maybe this forced weekly social interaction is a good thing?

I don't know.

I Need Sunshine!

We have had a string of cloudy days, and my mood is feeling it. I feel dead and lifeless. If I had feared being agitated after going down on the Zyprexa, especially in the springtime, it hasn't happened. In fact, I have been able to sleep, and I spent most of the day in bed.

Sometimes I wonder if I should move to Florida, or at least somewhere south of here. The problem is, I don't really like heat- especially not combined with humidity. And I have family in the Northeast, which is keeping me here for the moment.

It took me a while to figure out the seasonal component to my illness. I don't even think they had light boxes during my first hospitalization for depression during in the mid-1980's. No one talked about SAD. It would be a decade or so before I read about it, and realized, that is what I have! And no wonder I seem to spend every December in the hospital.

I actually had a therapist who tried to convince me that I found the holidays traumatic and depressing, and that is why my depression would always break through whatever meds I was taking each winter. So I wouldn't have to see my family. And I knew she was crazy.

For years, I would dutifully go to a therapy for a year- and then generally change therapists after that year (which seemed a respectable amount of time), because I didn't find them that helpful. There are some exceptions- I did have 3 therapists who were helpful, and I only left because I moved.

When I started working again 8 years ago, and lost Medicare, and had private insurance- I tried going to therapy a couple of times. But the in-network therapists that I tried weren't that great, and I didn't have the money to go out of network. Some were actually atrocious! And I gave up on therapy for a while.

But when I moved here, I realized I was very isolated, and could use some support. After trying two in-network therapists, my parents are now paying for me to see someone privately. I feel bad about this- I make a decent salary- but I also have a lot of debt, and it would be hard for me to pay myself. Not impossible, but hard. Especially if I want to do things like have a gym membership and have a personal trainer once a week.

I like her. I do find her helpful, although it is hard to say how. Perhaps she is just social support. She does talk a lot about mindfulness, which I like- but I can't go the whole way to DBT, of which she is a big believer. DBT is just too complected, and actually seems to add more layers, making me less mindful in some ways.

During my years on disability, DBT was recommended to me, and I dutifully found a DBT group at a local hospital. I cut myself at the time- so the doctor said that this was the thing to do, in terms of research. Nowadays, they would call it evidence based medicine. But you have to look at the individual.

I was deeply depressed at the time, just out of the hospital, on disability, and I didn't know if I would ever be able to go to school or work again. I wanted to be a functioning adult human being, but I didn't know if that would ever happen. And so, I didn't know if I wanted to live.

It seemed to me that DBT was nothing but a string of coping mechanisms- ways of getting through the moment, but with no promise of function (how can you study when you are having a tea ceremony?). I didn't want my life to be one long string of coping mechanisms. I didn't know if I wanted to get through the moment. My distress was existential.

So I hated DBT. And I hated the rules of the group. And I also was very out of it- and inappropriate, in the sense that I had no idea where other people were coming from, and that some people where finding it helpful. I was totally self-focused at the time. And I managed to get myself kicked out of the group. They decided to enforce a rule with me that they did not enforce with anyone else- that my psychotherpist had to be at the hospital, and she was not.

I should never have been admitted to the group, I was just too depressed. So my view of DBT is probably unfair. And in fact, I really can't remember anything I learned from the group!

So I pick up little bits of it from my current therapist, like "opposite action," and it is like learning them for the first time.