A psychiatrist sent me into an emotional flashback

[Liliuokalani]

I just posted this on the OOTF website as well, but I kind of thought it would also fit here and, well, I need all the support I can get. I went and saw a psychiatrist today, a new one, because I am almost out of my anxiety medication and my primary prescribing doctor is in another state. Since Xanax is restricted, I needed a new doctor. I realized this psychiatrist sent me into an emotional flashback, I realized this of course a few hours after the appointment.

I came in for test anxiety and wrote that down on the introductory paperwork. He hardly asked me any questions about who I am, my life, my past psych diagnoses or experiences. He just kind of launched into this exam and started throwing advice at me. He told me, well, in order to do well on a practical exam like this (I am a medical school student and I go interview a bunch of pretend patients and write patient notes, basically they're checking to see if I can handle being an intern for eight hours) I just need to practice as much as I can. He's like, go to the clinic, I'm sure they'll take you, and then just see like 40 patients and write notes until it's all muscle memory and that will help with the anxiety. And then he just kind of occasionally ask me about my fears and my feelings, and then stop again to just chuck a bunch of test taking tips at me again for a while, while I just stared at him and nodded. He was kind of like, well what's the big deal? You're catastrophizing and you just had to stop doing that the best you can, use some techniques to help out with that.

WHAT TECHNIQUES! You're giving me test taking skills and I'm looking for anxiety coping skills. I know I'm supposed to practice, but I get so anxious I just avoid it altogether and I'm coming in for treatment for that! I shut down! I freak out! I know how to succeed on this exam and I can't bring myself to actually go through the motions. I tried to explain this and he just kind of skimmed over this and was trying to basically minimize all of my catastrophizing. What makes your situation so special? What happens if you fail? I understand using logic to try to bring down my anxiety, but I already have the logic part down or I would not be here. That's not what PTSD is about. It's about your body freaking out in spite of your mind. CBT only takes you so far in that respect I think. And if he was trying to use CBT I don't think he was doing a great job of it.

He kept telling me what to do and not how to do it. And it reminded me of anytime I came to my parents, feeling hurt, vulnerable, and asking for some validation and some help. I got no validation or statements of empathy from this guy. Not once. I felt like he was just chucking advise at me and hoping some of it stuck. At one point he even said, "are you going to try practicing a lot? I mean you're polite and you're telling me yes but are you actually going to do it?" What are you, my dad? Are you trying to manipulate me into making promises I can't keep? And then at the end of the visit he said, well I'll write you a prescription for a lot of refills because I don't know when I'll ever see you again. What? How about telling me when I should follow up with you, or trying to speak to me about the importance of a follow up. To me it just was kind of manipulative.

And when I left I just sat in the car and burst into tears. I had a practice scheduled at a hospital this afternoon and I just had a melt down and never went, just curled up into my bed and fell asleep for a couple hours. It just reminded me so much of my parents. Just hurling advice at me instead of asking me any questions or trying to explore my feelings. Not offering any real techniques that could help me through that anxiety. And when I don't really seem to be taking the advice seriously or disagree with it, they would just lash out at me and, as my therapist would put it, "take the ball and leave." "Well I'm just trying to help you, but if you don't want my advice then I don't know what you want from me," and then angrily storm away. No listening, no validation, just oh, well if someone is bullying you, here's a list of comebacks. And if you don't like those well too bad. I'm going to give you lots of advice to handle a friend without ever having met this person, and if you don't like it then I will shut down the conversation and offer you no more love and support. It very strongly reminded me of that. Well I'm the psychiatrist and a doctor and even though this test wasn't around when I was in training I'm just going to throw a bunch of advise at you and try to manipulate you into doing it. Too anxious to follow my advise? Well I'm just going to brush right past that. Just figure out your own coping skills. Now give me money you don't have and be on your way.

I'm just exhausted now and feel totally hopeless for this exam. He didn't help me feel any better. After a while I just nodded at him blankly until he finally got out his prescription pad and wrote my prescriptions. I never intend to go back to that man, in fact he reminds me of the first therapist I tried, she did the same stuff to me. "Well why don't you tell your parents one thing you're appreciative of each month. Can you do that for me?" Just ignore all my fears of talking to my parents and getting backlash any time I try to have a serious topic. No, just manipulate me into making empty promises. My current therapist told me I ought to report that woman to the american psychology association. And as a training med school student and hopeful future psychiatrist, he really disappointed me. I left worse off than I started.

I just can't help but feel betrayed by the very field I believe in so much. These people if not careful can really mess someone up. When I finally got the chance to tell him about my abusive family he finally shut up for a minute and changed his tone for a bit but then went right back to the useless advice. I'm a traumatized person, maybe use a little care. That and early on in he pointed out how fragile I appeared and like I looked like I was going to cry in kind of a condescending manner and then I immediately started crying.

I hope not many of you have experienced this. But it's hard for us to trust, and these are professionals we are supposed to be able to trust. I mean, we open up our hearts and souls and are vulnerable in these sessions. What a shame.

[C.]

I had a similar experience w/a psychiatrist about 3 years ago, except I was in a strange time period of my recovery.  I was grieving and recently on meds, my emotions weren't regulating well and I'd fluctuate between euphoria and anger a lot.  At the time I got really angry and irritated w/him for being so incompetent so I used my bullying skills to mock him and ended up just laughing hysterically and leaving...I must have come across as totally insane at the time to him. 

But honestly he just looked and behaved in such a ridiculous manner I couldn't help myself.  Bottle cap glasses, scrunched up nose, short & skinny stature, a couch, an arrogant attitude, he was a walking Freudian sterotype...ugh.  The thought of the stereotype got me laughing and I said I was done, didn't want to finish our "assessment."  He got really mad and his face turned red when I said I was done, which looked even more comical, and I started to laugh at him.  He looked like that angry Sam character in Bugs Bunny cartoons.  The thought made me laugh harder.  And then he got madder, and I laughed harder.  At his office door he was so angry I don't think he could even talk.  I remember him red faced, tense, and an exaggerated swing of his arm up to point the way to the exit.  And I was laughing so hard I practically had tears.  My own T laughed a little, commented that must have been very unpleasant for both me and the therapist, then refocused me on recovery.  One of those times when I decided to focus more on my own health, healing and recovery, and not put more energy in to a person not interested in changing his treatment method or in my perspective.

So yes, there are sadly "bad" therapists, psychiatrists too.  I'm so glad to hear that you have a skillful one who listened and even encouraged you to advocate for yourself.  In my situation I did decide to write him a short letter describing from my perspective how he'd been inappropriate and misunderstood me.  The next day when I dropped off the letter I spoke w/the receptionist who was kind and laughed herself a little at his response to me.  He wrote a curt, unpleasant response.  I think that I ripped the response up in to pieces.  And at least I'd said my piece.

[Liliuokalani]

Wow, that sounds like I would start laughing too. Actually when I was working at a grocery store I moved a cart I thought had been abandoned to a safer spot and this guy got super angry at me. He was red in the face and totally had Harry Potter glasses. I was trying really hard not to laugh while he was yelling at me.

The thing is, therapists and psychiatrists are supposed to be weary of transference and counter-transference. If someone starts to mock or try to piss us off, we're not supposed to get really angry and react, because the patient is suffering, and you're supposed to be modeling self control. In my psych rotation for med school I learned early on to acknowledge my feelings but not react strongly back at a patient that is laughing at me. But this guy sounds kind of nuts himself. Which is something else I've realized. I think my first therapist was actually PD'ed, maybe histrionic. Some therapists should not have become licensed, because they maybe got into the field seeking their own therapy subconsciously. I think this psychiatrist I just saw is just in it because he knows in psychiatry you can make a whole lot of money if you're in private practice. Anyway, my first therapist begged me to tell her why I wasn't going to go back to see her. I felt like I was breaking up with someone, I kept saying no. But then finally I told her very politely that I just didn't think she was the right fit, and that I feel like I'm being blamed for my parents behavior. And her response was "oh well, I'm not like that at all and I don't appreciate your tone. So have a nice day." As if I was bullying her! Good lord.

[Kizzie]

Oh dear Lili, you are trying to do all the right things to help yourself and you end up getting a high school guidance counselor (pretty good money for that kind of advice). It does sound like he's is in it for the wrong reasons - good that you know it and didn't end up thinking you were the problem, that would really be adding insult to injury.   

My H reminds me when I run into people like this that there is always a bottom third in any graduating class.  So true     

I'm sorry you went through this at such vulnerable time     

[Liliuokalani]

Thank you Kizzie, I appreciate both of your replies to my recent posts. Unfortunately the past few days have been total pressure cookers. I keep blaming and shaming myself inside for not practicing more. I think part of it is that I am trying to protect myself from criticism of those that I'm practicing with. I guess the good thing is that the standard patients I interact with won't be criticizing my performance afterward. Usually on the day of the exam I get kind of a weird calm, I think it's relief that the day has finally come and then it will be over forever and ever. I hope that happens. I wish I had gotten myself to practice more. But I also remind myself that, well, technically everything I have been doing until this point has been practice. We did little mini clinical exams in my first two years of medical school. I have been interviewing and examining patients, coming up with possible diagnoses, and thinking about what tests I would order this whole year and a half of clinical rotations. I'm a hard worker and I'm always trying to put myself into a position of being a great intern someday. I really hope this kicks in on the day of the exam.

And I haven't been totally without practice. I did a few sessions with a friend and I also have been drilling myself in my head about questions I would ask and possible diagnoses based on a patient complaints. So that's better than nothing. The thought of going and practicing on a whole bunch of patients all in a row, honestly in theory it's the best thing to do, but as a highly sensitive, introverted person, that would completely tip me over the edge. If the psychiatrist had bothered to find out any of that information, I think he might have come to similar conclusions. There are advantages to being a highly sensitive empathetic person in the field, but I have no intention of doing a "revolving door" sort of practice where I see a whole bunch of patients to get as much money as I can. I know I don't fit well with that, I would do much better in a private practice with fewer patients that I spend much more time on. I think that as doctor's offices start to rebel against health insurance companies, many practices have begun already, the practice will swing back in the direction of, let's see fewer patients and take more time with them.

But until that time, I have 15 minutes to see my patient and 10 minutes to write a note, and that's supposed to be plenty of time. So that's what I have to train for. Hopefully these few sessions with friends is enough to get me in that time crunch. After that I think it's up to God and my subconscious brain. If in the end I fail, I will forgive myself and move on the best I can. If I pass, I never have to do this ever again!!!!!!!

[Kizzie]

Hey Lili - was your session yesterday?  How did it go?

[Liliuokalani]

How sweet of you to check in! Actually yeah my test was the previous day. It was... really quite a slow and agonizing day. I really felt in the morning that I could kind of barely keep my wits about me. But I kind of repeated to myself, this isn't life or death. This isn't an emergency. It's a test. I ate a little bit. When I got to the test center the xanax started to kick in but it only helped a little bit. Actually what helped more is that I took a look around and saw that other people were visibly nervous. Especially the girl next to me. And that was a HUGE comfort. Med students, I don't know what it is, but every other time I've taken a test everyone around me seems just really mellow, and I'll be like oh many I'm so nervous! And the response I get is, oh, really? That's the favorite response that bugs the * out of me whenever I'm open about my concerns. Oh, really? That usually means to me, oh I have no idea why you would feel that way.

But the girl next to be was burping, shuffling around, twitching, sighing, and when I was like, man I can't wait till this is done, and she was like, yeah geez! I felt better. Finally another student that is open about nerves! And actually the whole group was really quiet the whole time, we were all really nervous and taking some sort of either sleep aid or anxiety medication. That wasn't typical. Usually no one talks about being nervous and just acts weirded out that other people are. It's almost cocky. Actually the guy next to me kind of tried that a little. He said to me, "do you feel like you're getting enough time for the rooms?" I think he asked this because I was usually the last one out of the room. I replied "no, I wish I had more time." And he did the "oh really?" With a surprised look on his face. Nope, you're not doing that to me. So I replied "well I would be more nervous if I left the room early because then there would be a big chance I missed a lot of stuff to ask, so I take my time."

Shut down! He left me alone after that. He mumbled something about how he agreed or something and then stopped.

Near the end we all just kind of went into "don't care" mode, including the trained standard patients I think, and the nerves just kind of melted away into exhaustion. I think I did about the same as others and I'm feeling optimistic, hopefully I did ok, sadly I don't find out for like another month. But I said to myself that if I made it the whole day without pooping in my pants I was victorious. So... I was victorious.

The next couple of days I felt like I got hit by a bus but I'm feeling better now. I am not nearly as anxious about computer exams. If I can take an exam in my pajamas I'm ok. It's this performance stuff that kills me, luckily there aren't too many times that happens. I think the next time I would have to do that is to become board certified as a resident. So when I'm a doctor. I hope by that point I will develop some way of handling my feelings better. They just become incredibly overwhelming, this feeling of doom and failure. And maybe between my therapist and I we can sort out a few more coping techniques.