From the U.S.: I recently started seeing a psychiatrist for ADHD. She also offers psychotherapy and comes from an ISTDP and CBT approach. I am now on medication for that and requested therapy to help me understand and manage some of the issues my ADHD has caused. During my first 30m med management appointment yesterday, it became clear I was more depressed than I had considered myself during intake.
We ended up sort of arguing about me going on a more rigid schedule – set bedtimes, work periods, meals. I agreed multiple times that it could help and that I’d at least try, she kept trying to get me to buy into the idea with much more enthusiasm than I can honestly muster (strictly scheduled periods of my life have been some of the worst due to a non-24 sleep cycle, and I have a lot of baggage and resistance resulting from it). She kept repeating that it needs to be for me and not for her, but was more like her demanding I feel something I don’t. It had a combative feel to it, me doing nothing other than agreeing to at least try and agreeing it might help, her trying to get me to say things like yes it will help (she insisted I say yes or no, because not being sure “gives me an out” or something.) There was little effort to persuade me to see it her way, just the refusal to accept my response as acceptable.
She then said she doesn’t think psychotherapy can help me unless I’m on a schedule. It came off very much like an ultimatum, and she repeated this in reply to an email where I sent the schedule I put together. Accordingly, she has not agreed to treat me yet even though that’s one thing that appointment was supposed to address.
Unfortunately, sticking to a schedule feels like an overwhelming goal at this point, something that will take willpower I seriously don’t feel like I have available right now (e.g. forcing myself to stop what I’m doing and sleep when I’m totally wired at night due to the non-24, and having one of my main drivers for going to therapy be that it’s nearly impossible for me to begin and stay focused on my work). If I did have that willpower I might not be seeing her at all, because I could just pull myself up by bootstraps and so forth. So it just feels like she said “stop having the problems of a depressed person and I’ll treat your depression.”
Again, I’m not totally opposed to this, but I’m a bit angry about feeling browbeat into it if I want help. I have so many other things I want to work through besides depression – remember I requested help specifically for ADHD, not depression, but I also have a serious physical illness that has just worsened and am also dealing with some loss. My intake and first regular appointment have not really been long enough or open-ended enough to address any of this, and my next appt will only be a 30m med mgmt as well.
So, I don’t want to undermine this if it’s a reasonable but poorly received intervention, but now I am very hesitant to continue with her. I wonder if everything I don’t agree to immediately and with enthusiasm will result in an ultimatum, I wonder how skilled and empathetic she actually is if I come away from my second meeting with her feeling angry and doubting her skill and not wanting therapy with her anymore, I wonder if any hesitation will have her perceive me as not committed enough to work with, and I wonder if everything I’ll be asked to change is going to be something that feels like a monumental life change rather than being given the space to chip away at things in smaller, less intimidating chunks.
Does this not bode well for the therapeutic relationship? Should I look for someone else before getting too invested in this relationship? Was it reasonable to argue with me and basically turn it into an ultimatum for refusing therapy when she encountered ambivalence? It took me a long time to work up the energy to seek therapy, and the last thing I need is to spend months finding out for sure that we’re not compatible.
Thanks in advance for any thoughts or perspective you can offer.
Thank you for writing. I’m impressed that you are thinking so carefully about how to get the best treatment possible.
Without hearing from the therapist, I can’t fairly evaluate what went on between you. But what I can do is validate your experience. The most important factor in determining the success of treatment is the connection of trust between the patient and the therapist. Therapy is difficult. You need to feel that the person who is caring for you is in your corner if you are to take the personal risks that come with self-disclosure and efforts to make fundamental changes.
You don’t feel that connection with this provider. The help she is offering doesn’t feel helpful to you at this point. That doesn’t necessarily mean that either of you did anything wrong. It does mean that it may not be a “match.”
I therefore encourage you to interview another therapist or two or three until you find someone who inspires your trust and who offers a plan that you feel you can manage.
If, after seeing several therapists, you still feel that you haven’t found the right “fit”, it may be that you are expecting too much or expecting the wrong things. That then becomes something to honestly explore. But people usually find a professional they feel is right for them within the first few interviews.
I wish you well.
Dr. Marie
