Thursday, September 4, 2008

:: :: more strategies, less medicine! :: ::

Despite having started seeing my therapist during the first week in July, I have only met with her five times including today. During these meetings, I have grown increasingly concerned that we’re not a great fit.

Maybe concerned isn’t the right word. Maybe annoyed is the better word. I’m annoyed by her. I’m annoyed by her style of interacting with me. I feel as though she’s listening the way casual friends listen: waiting for something to latch onto and say, “Yeah, that happened to me, too.”

Literally.

At first I was glad to choose someone with a Ph.D. who had also gone through Postpartum Depression and who had struggled with anxiety at times in her life, but now I see it as a problem: she relates to me too much and unfortunately, I don’t really relate to her. She seems to think that I’m just like her, but really I’m not totally convinced that she deals with her life all that well. All of which is to say that I’m not sure she’s the right doctor for me.

The other thing that bothers me is that we spend a good ten minutes each session talking about medicine, despite the fact that she can’t prescribe it. Today it was how I should be taking something before bed because once a week or so I wake up with a bad anxiety attack. But six nights a week I don’t. I’m not totally comfortable with taking something just because I might wake up in terror and panic. Furthermore, the middle-of-the-night attacks are becoming less frequent. Isn’t that a good thing?

She also suggested I talk to my doctor about adding an anti-anxiety medication on top of my anti-depressant as well as talking to him about prescribing a higher dose of my anti-depressant during the week before my period because we’ve identified a pattern of moddierness (it’s a word, I swear) and less ability to cope with my anxiety and depression during that week.

The thing is, I started taking the medication because I trusted my general practitioner that it was the right thing to do. I really felt in my gut that something was Not Right inside and it wasn’t just me. But now, a couple months later, I feel differently. I am the first person to acknowledge that the Zoloft has helped. I also trust that it will continue to help. However, I feel like my therapist wants to throw a lot of drugs at this problem and wait for me to get better so that I don’t ever have to learn better coping skills. Two weeks in a row I have asked for specific tools and techniques for identifying and dealing with stress and two weeks in a row she has suggested that I’m not yet “in therapeutic range” with the medication and so I’m “not myself” and therefore having anxiety that I “wouldn’t otherwise be having.”

In some ways it’s like she wants me to be kind to myself: not to berate myself for feeling bad still a lot of the time because it’s not my fault. I appreciate that. I do. I appreciate, also, that I can’t just make myself better. I can’t think myself out of this. But still. Something in her logic seems strange to me. Anxiety I wouldn’t “otherwise” be having?

Otherwise what? Otherwise when? Like if I lived in a different country or spoke six languages or had brown hair instead of whatever color I have? Maybe if I were born to different parents and lived in a different suburb of Columbus? I mean, the thing is: I’m feeling this way right now (well, not right now). Other than taking more medication and waiting to get to the therapeutic range, what might I be able to do about it?

Furthermore, as I told her, I’m doing a lot better when Evan’s at daycare. I have little victories all the time and I’m enjoying making things and reading books and taking walks (when it’s not 98 degrees and 98% humidity and Beijing-level air quality). I haven’t had a single panic attack while I’ve been by myself in weeks. I only have them on the weekends and only feel dread and anxiety when I’m around Evan. It’s like I learned to have this response around him and now I don’t know how to reverse it. I don’t know how to associate my time with Evan with positive things.

After I told her this she said, “I remember when I was getting over my depression getting out of my car one night and looking at the sky and saying to myself, ‘Wow! What a magnificent sky!” and then thinking what a long time it had been since I’d thought something like that. You’re looking for that.”

“YES!” I said. “I’m looking for that.”

And that was it. She went back to how I should talk to my GP about altering my medication.

The one very good thing to come out of therapy today — good enough that it made the whole session worthwhile — was a conversation we had about my evenings with Evan. She asked me to run through the evening, you know, like, what we do, when we do it, how Evan reacts, how I react. And then we talked about specific ways to alleviate specific moments of tension. For example, when we get home, Evan’s crazy hungry, but he also wants nothing more than to be held, which obviously I can’t do if I hope to feed him anytime before he starts chewing his own arm. (Side note: did I ever tell you that Evan gave himself a hickie on his arm when he was a baby?) So I tell him no and try to distract him while I get some semblance of a dinner together for him, STAT!

Well, she said, “Maybe what he really needs right then is you.” What if you picked him up and let his dinner wait for a few minutes? Or what if you sat down together with him in your lap and had a small snack first? And I was like, DUH! How smart! YES!

And so of course tonight we tried it — I picked him up and talked to him and wandered the house with him for a few minutes and then he played nicely while I got dinner ready. He got antsy for the food, finally, so I let him eat some while I poured his milk and got him started at his high chair with ravioli while I continued to work on the carrots.

Evan’s mood was better. My mood was better.

The rest of the night I tried to think of everything the same way: what need is Evan trying to express right now? When he started trying to get at everything forbidden in the garage I decided he wanted to explore but he also needed to be engaged. So I found ways to fulfill those needs. Suddenly, I didn’t feel like I was telling him “No this” and “Don’t that” but instead was helping him have a good experience. In turn, I felt more like I was having a good experience. I felt less bored and less naggy. I maintained limits (”No, Evan, absolutely no Clorox”) and redirected his energies when I needed to, but I felt like I had somewhere to redirect them to. Somehow I’d sort of forgotten that part.

And lo and behold: I had a good night with him. The first one in a long time. Not just an OK night but a night I actually enjoyed. I would have told you that thinking about his needs instead of my own was what was causing the problem, but maybe it’s really the opposite, at least on some level.

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