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?