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Friday, September 02, 2016

Psychodynamic therapy

Today I officially started psychodynamic therapy as an outpatient. (I am still in hospital, but at a community hospital which is an intermediate healthcare facility designed for rehabilitation, primarily via physiotherapy. It is next door to and linked to the government hospital that I stayed at for 10 weeks in an orthopaedic ward.) This is at my previous hospital's psych clinic. When I am finally home in about two weeks' time I will continue as an outpatient at this clinic.

Just to let you know about the logistics accompanying this therapy: if I want to see this doctor for psychodynamic therapy at a subsidised rate, I need to also see the main psychiatrist-on-call I was assigned to on the day I was admitted after my suicide attempt. This psychiatrist is only for the psychopharmacological part of my treatment. But this psychiatrist happens to be an asshole. (More on that later.) It has to be an hour-long session every week on the same time and day, for a year. The doctor administering this therapy is really nice and pleasant, a deviation from the norm that is the government hospital doctor.

One element about this form of therapy is that it is fluid, without many directives from the doctor. Since it is the predecessor of psychoanalysis (featuring a couch and 'tell me about your mother'), it pretty much means I am supposed to talk in the stream of consciousness, and the doctor prompts from there when necessary. I started with a current trending topic in my life: medical care.

I shared about the TCUs i.e. follow up appointments I had recently. I can't recall the specifics because it has been a very fatiguing day. As I spun on and on, with prompts like, "It sounds like you have had a very bad experience with this hospital's doctors," I ended up summarising myself that competency and empathy were important traits in doctors I paid to help me. You really have to be interested in making me feel better. It seems foolish to have to state this but besides a couple of exceptions, government doctors don't benchmark their performance against how well the patient becomes after their care.

I gave a few examples of failed doctors and one of those was the psychiatrist I have to see for my psych meds. Things he does not do: address concerns regarding symptoms, explain rationales behind his prescribed treatments, adopt a genuine listener's posture and body language. One prime example is when I asked him to reinstate one of the medications I have been taking for years until I came under his care: Lexapro. I not only wanted to feel less depressive mood-wise, I also needed Lexapro to help me with anxiety. I am now only on Cymbalta but at a fraction of my previous dose. It doesn't matter if I feel fine with this regimen, or have equal or better ways to help (no, I don't want to rely on benzodiazepines, right?) Or even, at the very least, give me an explanation why doing without will make me better. His answer to why he was not going to reinstate one of my primary meds was, "Who here has a better track record of making decisions, you or me?" All while maintaining an arrogant posture of perhaps, a dictator. No shit!

Is it really too much to expect some bedside manners? Apparently so. As the therapy session continued, I once again verbally discovered that I need to feel validated, and that's why I feel so let down by medical doctors who don't listen to me. This asshole psychiatrist is not the only one of course.

My doctor then asked me if I had similar experiences feeling invalidated when I was young, because as we continued discussing this topic, he saw me getting teary-eyed. I didn't know why exactly either, so we had to wait till I thought up a reason. I eventually linked it to how I was written off as lazy when I was a child, when I couldn't wake up easily, springing out of bed full of energy as I assume children mostly do. I couldn't fall asleep easily at night, so I never could wake up early, feeling refreshed. It was insomnia. I also had low energy all the time, perhaps fatigue? But nobody knew. I was just a lazy child who often overslept for school and failed to complete homework on time. Maybe there was more to this, but by this point my hour with him was up.

Before I started psychodynamic therapy, I needed to sit down with this doctor thrice as he asked me about myself, my history, my childhood. Not everyone is suitable for this type of therapy. I wasn't told what markers was I being assessed against, but I will take a guess. I had emotionally traumatic experiences as a child that deeply affected me to this day. It is the same reason why the alternative diagnosis I have besides depression and anxiety, is chronic PTSD. I am not sure if my high sense of self-awareness also comes into play, or that I am willing and able to share vulnerable experiences I've had.

Well, I will keep going for this therapy and hopefully write more about it here. This doctor has the right mix of what I look for in a doctor-patient relationship. He listens well, never interrupting me mid-speech, not even for a phonecall. He engages me with eye-contact throughout the entire hour, and his body language shows he is totally focused on the session we are having; he doesn't even read or write any notes. He uses the right words where appropriate, like, "Sorry to hear that..." or "Correct me if I am wrong but it seems that..." He also explains clearly the rationale or structure of the treatment he is administering, to the level of my self-awareness. Not all healthcare professionals do that! Some just want you to adhere to a treatment plan because they say it is good for you. Hardly scientific, nor helpful.

Another thing I will keep on doing is journalling. It is different from writing online through tweets and blog posts, because it likewise needs to be open and unencumbered. Self-censoring for online posts means not all of your subconscious thoughts are being explored. I have thought however, how I can still share a glimpse of that which i journal. We shall see.

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