Why are pdocs always late? I’m always having to wait at least fifteen minutes after our scheduled appointment time. It’s not fair. Because of I was late like that, I would probably get a lecture on the importance of being on time. It throws my day and all my structure off. On days I have to see him, I can never plan for anything after. Anyway this time I decided to say something–
“Right on time, as usual,” I said, quite passively. His non-response indicated that he didn’t appreciate my sarcasm.
I had high hopes for the session. I wanted to drop the other medications I’m on–Lamictal and Klonopin–and start taking Nardil, as a friend of mine with social anxiety has found Nardil quite helpful. The problem was/is that my pdoc hasn’t prescribed Nardil in over twenty years as he had a patient almost die while on it. You see, there are some dangerous food interactions, particularly alcohol, cheese, aging fruits and vegetables, some meats, soy, and so on. It’s quite alarming. You could eat the wrong kind of cheese and end up in a hypertensive state and have a heart attack.
But if the ends justify the means, I think I can live with the reduced diet–and the risks. My pdoc, however, wants to exhaust all other options first. So, he increased my dose of Klonopin and added Xanax into the cocktail (both of which, I might add, I’m having trouble filling due to insurance restrictions–so frustrating). Anyway, I came out of my appointment disappointed.
Oh, and I also got lectured.
My perfectionism came up. I told him I’m frustrated because I don’t have many friends, and outside of my relationship, I pretty much only hang out with my girlfriend’s family. And since she has a large family, I pretty much bounce from one large group social gathering to the next. I don’t believe that type of exposure works. I need gradual exposure. I need to see small successes and build from there. I won’t get any better if I continue going to huge social gatherings. But I don’t feel like I can opt out of them, either. Otherwise, I would just sit around the apartment, isolated.
“It’s okay to avoid things,” he said. “In fact you need to take back control from your anxiety and start saying ‘NO!’ every now and then.”
“But then I’ll be completely isolated,” I said.
“You’re going to school, you’re starting an internship, you have a girlfriend–you don’t sound isolated to me.”
“I’m going to school online,” I countered, “which isn’t helping my anxiety. I’m scared to death of the internship. I’m too dependent on my girlfriend.” We sat in silence for some time. “I can’t help but think this way. I know my perfectionism is fueling my anxiety but I can’t control it.”
“Mike, it’s not perfectionism. It’s punishment. You’re punishing yourself for not being perfect, and by doing so, you’re giving control to your pain. You still have control, though, but you don’t feel like you have it anymore, because these beliefs of yours are so ingrained. I don’t think you’re challenging your beliefs enough.”
I’ve been in therapy for over a year–is that not enough? But he’s right. I do not feel like I have control. I feel like I am my anxiety. I am my beliefs. I am who I say and think I am. How does change occur, though? It’s easy to intellectualize this process, but that can only take me so far. Change is deeper, in areas that I don’t like to touch. In areas I don’t know how to touch. When I do touch them, I shut down, I get flooded, and I push away.
He also brought up the issue of learned helplessness. I’ve failed so many times in the past, I do not believe I can succeed. I’ve taught myself how to fail. I’ve let my anticipatory anxiety get the best of me. I think I’ll fail, therefore I will fail. But maybe–just maybe–being conscious of this will help me change? I hope so.
***
Later on in therapy that night, my therapist asked, “What does it mean to be perfect? What does perfectionism mean to you.”
“It means I avoid being judged negatively,” I said.
There’s more but I don’t feel like typing it out. It was a tough session, to say the least. He pushed right up against my beliefs, and I pushed right back, shutting down in the process. I feel like we’ve been at a standstill for some time now. Why does change have to happen so slowly?
Unhappy Happiness 
I find perfectionism to be something I’ve learned from since I can’t achieve most of it. When I challenge myself so much and end up not doing any of it, I realize time after time I should just stick to what I’m capable of within my comfort zone.
My instinct now is to just say to myself “it is what it is, I’m alive and shit happens” and sometimes much more in depth thinking like that, like people think I am quiet but I am still sitting here in this chair on the computer, that reality as a fact is not going to cause a million explosions to send me down to hell in a fiery death. But I choose to move in a gradual direction of trial and error in the process of change, there is still hope.. I am not giving up completely just not going past my comfort zone all the time. That’s what I’ve been thinking.
It’s great that you’ve been able to find ways to manage your perfectionism. I cannot seem to set up any boundaries. I think it will take time, but I will get to the point where I won’t push myself so hard–I’ll stay within my comfort zone, as you say–as I know this behavior sets me up for failure.
Hey Mike,
I agree that change takes place very slowly – and it can really be frustrating when you’re tired of waiting while battling with your depression. I think I have what you call perfecionism – Although I think I’ve been learning slowly to be OK with my imperfection, it is still difficult for me to stop criticizing myself for being unable to do what I want to or should do adequately.
Although you may find it difficult to believe, I think you’re doing great because you’re always brave enough to look into yourself. Some people don’t even bother to do that. You know, you always sound so nice and friendly when you visit my blog and leave your feedback. Although we have never met in person, I have a feeling that you are nice. Your girlfriend must like you because you’re a nice guy! 🙂 I hope you’re feeling better, Mike, and thank you for being always so nice to me!!
Thanks, Takashi! I do consider myself a nice guy! 🙂 I’m also grateful for the fact that I am open to looking inside myself. Most people don’t go there, at least not in my family. Even though it’s been hard, I’m glad I’m going through it.
Sounds like you might need a new pdoc or to add a therapist who will stop keeping the therapy at an intellectual level. The pdoc’s habitual lateness is disrespectful to you and rather than using sarcasm you will need to confront him on it directly by telling him that if he can not see you on time then you will seek out another who can fufill your need to be seen “on time”. Much anxiety and fear arises when we feel our needs will not be met, and you’re starting out every seesion not getting what you need. It’s not about control, but about being clear as to what you need.( When confronted your pdoc may try to say you are trying to control everything….be warned)
Renind this guy that he’s not the “only game in town”!
You’ve given th therapeutic relationship a year or so to develop and it seems as if he is only helping you remain on a surface level. ( meds,in the long run unforunately also add that, and keep clients dependent and in therapy far lomger than they need to be… my opinion). I would try to directly confront him with your issues regarding the therapeutic alliance you share,and see what happens before changing therapists. It may help resolve the frustration you’re feeling, not only in therapy, but also in your life. If you get nothing but silence or excuses back from the pdoc….it’s time to switch….you’ve done all the work you can with this guy.
Valid points. All things I need to think about. As for therapy, I don’t know if I can totally blame my therapist. He’s doing the best he can, with the tools he has available. He does his best to get me to go deeper, but when we do, it’s my body that shuts down, not him. It’s just going to take practice. In other words, I don’t know if changing my therapist will do any good. Plus, I’d have to start over in a sense. It’s taking me a while to get to the point where I at least somewhat trust him and can share what’s going on.
Thanks for the feedback! :_
My old pdoc, who is still my son’s pdoc, is always late. The last time I took my son the pdoc kept us waiting 55 minutes! And then he saw my son for 8 minutes. I wrote a letter expressing my dismay about this, and he called to apologize. What else could he really say? Talk about screwing up my day!
As for the perfectionism problem, I can so relate. It all stems from never being good enough for my mother, and is very difficult to overcome. It has affected my life in major ways, to the point where I really have made nothing of myself because I never thought I could do anything well enough.
I don’t really understand the concept of challenging your beliefs. My t tried to do that a couple of times, and I felt totally invalidated and minimized. I said, “I say things are x and you say things are y and I’m supposed to believe you?” Why would I believe what my t says, since we don’t have a relationship outside of the office, he only sees me 45 minutes a week, and how could his perception of my life be more correct than my perception? You don’t feel demeaned when your t tells you that your beliefs are wrong?
Hey Harriet. I don’t think it’s so much I say ‘x’ and my therapist says ‘y’ … it’s I say ‘x’ and my therapist says why–why ‘x’? I think it’s about him showing me there are other possibilities, which allows me to see that ‘x’ may not be the right answer. But that’s all in theory, of course.
My t never tells me my beliefs are wrong. By definition, beliefs are never wrong. They can be irrational, and thus not serve us, but they are never wrong, in my opinion.
Anyway, thanks for the comments, and I hope your Thanksgiving run when well! 🙂
I see your point. I guess I’m just way too sensitive, because when my t points out how he perceives a situation of mine I think he is telling me that I am seeing it wrong (even though he doesn’t say that). That’s really good that you don’t feel that way when your t tries to show you there are other possibilities. I don’t think I would like it if my t told me my beliefs were irrational either. Because I believe them! He has told me that my thoughts about myself are distorted and not real. But I think maybe his thoughts about me are distorted and not real. Argh, I get so confused. It’s very difficult for me.
Well, I don’t always see it like that. I mean, if I did, therapy would be easy and I wouldn’t shut down when he begins to push against my beliefs. It’s more like I understand *logically* that some of my beliefs are irrational, like my belief that everyone is secretly laughing and talking about me behind my back. I can refute that logically, but deeper down .. well, that’s another story.
Hey Mike,
Do you think it might be possible that he is being late intentionally? I don’t mean that he is trying to upset you but he may be doing it intentionally or unintentionally because he wants you to (as you referred to it in your post) be assertive?
My “safe place” to practice assertiveness was with my dad. He used to be the kind of person that could snap very easily and blame everything on others. So, for most part when he started his tirades I just said nothing but there was a time when I decided that he won’t be able to blame me and started standing up for myself and talking (actually shouting) back. It was really difficult at first but the more I did it, the easier it got. Eventually, I did notice, that in my dad’s case it was more of a habit/pattern of his that I couldn’t do much about as he wouldn’t listen but at least I did not feel bad after something like that has happened.
So, I think you could give it a go and “discuss” the beginning of your appointment time. I remember many situations where it would’ve been easier said than done in the past. But you have to start somewhere. Even if you do go overboard, you can simply explain your situation. I think he would understand (and my guess is he probably would already know).
I read the Wikipedia page on learned helplessness and the dog example was interesting. I was thinking about how I changed some of my beliefs and habits. You’re right that sometimes even if you know what you want to change may not be easy. Perhaps, as humans, we might have something that dogs don’t have. Maybe being aware of our situation or being able to decide and take actions (in certain situation) that requires thinking is something that dogs are not capable of. I’m just guessing here.
In any case, maybe it’s just me, but my impression from your writings is that you are still going and you do want something to change. You just haven’t found all the answers yet.
VanDamme
p.s.:
Good luck with your schoolwork and presentations.
Hey. Thanks for the advice. I’m going to *try* to be a little more assertive next time. I also feel like just by being aware of my behavior, it can be changed. In the case of the dogs, they don’t have that higher-level cognitive abilities. Anyway, for the most part I do want change, I want to be able to interact and be a part of something and have a job and friends, etc. But sometimes it does feel good to go through a negative social situation, because it reinforces those negative beliefs about myself.
hmm… Yah. Change is scary and it happens pretty slow. I changed a lot though. Through counseling and being with my wife who has completely different perspective on things. I like the new me better. It took 4 years of struggle but I want to say that change is possible. I see that you are trying hard. Keep up the good work. Just don’t give up and before you know it you have already made some progress towards the new you.
I am such a different person from 4 years ago and I feel improved and confident and great about myself.
goodluck
Thanks! 4 years sounds like a long time, but I’ve been suffering from social anxiety and depression for like 11 years. It’s going to take longer than a year for significant change to happen.
oh by the way, my psychiatrist is always late too. My last one had the same problem too. That’s why I changed. I feel like I want to change again but it’s kind of a pain in the neck. Plus, I have a really really great therapist so I feel like as long as he prescribe the right meds for me I’m good for now.. Do you have a therapist?
Yes, I have a psychiatrist and a therapist. I also don’t want to have to go through the trouble of switching. Starting over is a long process I don’t have the energy to go through right now.
My pdoc is sometimes up to an hour late which I don’t appreciate. I have to rearrange my day on my appointment days. The last time I seen him his receptionist stuck someone in just before me which made my appointment even later. I find this stressful as I can’t sit in the waiting room waiting for my appointment. I almost always sit outside and wait. Too much anxiety involved.
I too have a comfort zone that my pdoc is always challenging. He has a tendency to want me to take a big leap out of it. I try to work on it in little steps as I feel able to do so. Sometimes I think he doesn’t get how hard this is (agoraphobia) for me to work on. Although maybe he does.
That’s so frustrating. I, too, find it so nerve-racking waiting in the waiting room. I should try to just stay outside and let him find me or something or bring head phones and zone out.
I agree with you on little steps. I think that’s the only way. If we continue to flood ourselves with anxiety in certain situations, we’ll never get better. Gradual exposure is key, at least in my opinion.
Mike, you are so self-aware. One day you will smash through that barrier, I really believe that.
About the Nardil, I actually agree with the psychiatrist. Other options should be exhausted before trying a drug like that. And, believe me, just because a drug worked for one person doesn’t mean it will work for another. So many people recommended Lithium for me, they were convinced it would work, I was convinced it would work. But I reacted extremely badly too it. So don’t be too disappointed, it takes lots of time (unfortunately) to find a right drug combination.
*Hugs*
Thanks! Yeah, I do agree with you on the Nardil. I just need to keep trying differt combos. Anyway, I hope all is well with you. 🙂
Hi there!
Have you tried Luvox? I’m on a high dose of that and it helps a bit with the perfectionism and anxiety, plus I’m on Welbutrin so I don’t lose all romantic feelings. One glitch. You can’t eat grapefruit. It won’t kill you but it metabalizes your med too fast and since i don’t really like grapefruit no big loss.
I’d really have to be at the end of my rope to go on an MAOI. Those are really dangerous.
Just grapefruit. Weird! I’d so not be on it if I couldn’t have oranges, etc.
Hey. I haven’t tried Luvox, but I have tried other SSRIs–they really didn’t do anything for me. That’s strange about the grapefruit. Is it all citrus fruits or just grapefruit?