The Epic Quest for a New Prescriber

At my last psychiatric appointment, my prescriber of nearly 3 years (an awesome advanced practice nurse) informed me that she’s retiring – and the community mental health clinic where I’ve been receiving care isn’t hiring a replacement. There wasn’t any offer to help me find a new prescriber or set me up with one. She just gave me a list of numbers to call, and sent me on my way.

I knew I should’ve started the search immediately, but I was stressed out by the idea so I did what I do best: I procrastinated. I got distracted. I focused on just about everything else. To be fair, “the incident” happened soon afterward; I needed time and energy to recover from that. (Things are going well, by the way, update pending.)

Two months have passed.

Somehow my lamotrigine & clonazepam prescription refill cycles got de-synchronized, so I’m in a kind of weird situation. I used the last lamotrigine refill a few days ago; “additional refills require authorization.” I have 26 full doses left, including today’s. There’s still one more refill on the clonazepam.

So it’s crunch time. I need to find some way to refill these medications – preferably before I run out or resort to cutting pills in half. I honestly fear for my life if I have a disruption in access to my meds – if not my physical life, my ability to continue my activism and maintain healthy relationships. Perhaps more importantly, I fear losing the ability to do the things I need to improve my life – such as completing my degree, finding a job that pays a living wage, consistently functioning well in that job, and learning how to keep my home from becoming an unlivable nightmare. Even more importantly, I fear losing the ability to take care of myself, which includes the ironically (read: cruelly) daunting task of accessing and engaging in treatment.

These fears are among the most potent triggers for my worst depressive symptoms.

Oh, and by the way, my state just cut funding to community mental health. Clinics are closing or cutting whatever (whomever) they must to try and stay afloat. My current clinic no longer serves clients with private insurance, and it had to let go of its front desk staff.

jiFfM

Star Trek: Next Generation characters Picard and Riker both facepalming. The text reads: “Double Faceplam. For when one facepalm doesn’t cut it.”

So, yesterday, I began The Search. My counselor (who helps me with behavioral approaches to wellness) had suggested that my primary care doctor could possibly authorize refills, so I called his office. They said he “might” be able to, “depending on [my] situation,” so I made an appointment. I’m hoping he can authorize a one month supply of the lamotrigine, and if necessary I can return to him for a three month supply of both medications. (Clonazepam is a controlled substance, so any ‘new’ prescriptions not filled within 30 days expire and need to be reauthorized – at least in my state.)

Even if my primary care doctor can help me, seeing him for psychiatric consultations is not sustainable. I don’t have, nor do I anticipate developing, the rapport I’d need to literally trust him with my brain. I need a specialist who really knows what they’re doing, especially if and when it becomes necessary to make adjustments to my medications. (Which may be soon, I’m still trying to figure out to what degree my current problems can be addressed through music therapy and changes in behavior, vs meds.)

Ideally I’d like to switch to the other prescriber at my current clinic, whom Fox has been seeing and seems to like. If not her, perhaps someone at another location in the same agency – surely that would provide some consistency of care, right? I called the intake office; the person who answered seemed surprised I hadn’t been referred to another prescriber. “Well, you might want to call the other numbers on your list, because we’re currently scheduling for September.” “September?” “Yes.” I hung up on them.

I started making some additional calls. Bad number. We don’t do that. We’re not accepting new clients. We’re currently at capacity, but may be hiring someone, you can check back.

newprescriber1

My to-do list item on Habitica.com with several steps checked, reflecting the efforts I put in yesterday.

There are several additional numbers on my list, but most of the clinics are in urban areas that may be … inconvenient … to access. Middle class suburban snobbery aside, I anticipate that these locations are even more likely to be “at capacity” or otherwise struggling to serve clients for whom they’re the only choice.

So I’m gonna try calling intake for my current clinic/agency back, see what they can do for me. (I realized later that September is only about a month and a half away.) Hopefully my doctor can set me up through August, maybe September as well; if there’s any interruption in my access to meds it will hopefully be short enough that I’ll be okay. And I’d rather have this set as a backup in case my doctor can’t help me and/or I can’t find a prescriber elsewhere; the longer I wait to make the appointment, the later it will be and the more likely this is to become devastating.

I forgot to refill my prescriptions until I ran out – of course on the day I was running late and had to rush out the door. I tried to put in the refill request for the clonazepam first, but was unsuccessful; somehow my prescriptions got de-synchronized so I was out of refills with that Rx number and I didn’t have the new one to put in. I was in crazy anxiety rush mode, so I didn’t try refilling the lamotrigine – even though it had 2 more refills with that Rx number.

I asked Fox to go to the pharmacy for me and he did, because he’s wonderful. He said (they said) they didn’t have anything in the system for me. I was tabling at a pride event and he had to leave for work and it was Sunday, so there wasn’t really any opportunity to follow through on anything.

On Monday I realized I should’ve tried to refill the lamotrigine, better to have one of my meds than neither, right? That was no problem, but I had to speak to a pharmacy representative to deal with the clonazepam. The person I talked to at the pharmacy had an irritating tone to her voice and was too nonchalant, like there was no problem with them not having the information necessary to make sure I have access to a medication that keeps me alive. She didn’t even try to be polite like saying ‘sorry’ – but she did offer to fax my prescriber. And she explained that the clonazepam prescription had expired because it’s a controlled substance, so it has to be filled within 30 days.

I walked to the pharmacy with my inner voices screaming, an irritable mess, barely holding myself together. By the time I got the lamotrigine my ears were ringing and my eyes were so full of static everything was in a darkened haze and I couldn’t think straight and everything felt completely WRONG. That was after missing one dose – and it’s not even that high a dose. I took the dose – better to at least take one of my meds, right? and everything cleared within minutes. The difference was noticeable to Ron over the phone.

I had to play phone tag with my prescriber for a couple days, but I was able to refill the clonazepam today. I didn’t notice as much as an effect when I took it, except that maybe I’m a bit calmer? And I was rather sleepy, I attributed it to waking early from a bad dream, but the medication is known to make people drowsy. Ron seemed surprised I’m able to function at all taking [my dose] of it every day.

To be honest, between what ze’s been telling me about it and what I’ve read online, I’m a bit wary about staying on the clonazepam. Apparently it’s habit forming and it’s better not to take it for extended periods of time. But my prescriber added it for a reason – I think because even with my mood stabilized I was still struggling with anxiety. And I don’t know if I wrote about this yet, but my prescriber is retiring, so I need to find a new one within the next month or two. I’d rather not change my meds until I’ve developed a good rapport with the new prescriber.

So, yay, I’m back on my meds! I anticipate that going a day without lamotrigine and two days without clonazepam will have thrown my levels off; it might take a while for them to get back to normal. And I’m a bit shaken by how profound my (withdrawal?) symptoms were before I took the lamotrigine. I’d come to accept that I’ll probably be taking these medications for the rest of my life, and I’d rather do so consistently than risk going back to how things were before I started taking them. Still, this was a rough reminder of how dependent I am.

No Stigma, No Shame, More Happiness

I saw this on Facebook and wanted to share it. As someone who both wears glasses and takes medication to keep my brain from trying to kill me, I feel it is an excellent analogy:

FB_IMG_1496322585743

The text reads:

“I wear glasses. Can I manage without glasses? Well, yes, probably. I could squint a lot, constantly move up close to anything I want to see, take the bus or a taxi if I want to go anywhere. I could just accept that I’ll never be able to see eagles flying in the sky or whales jumping out of the ocean.

But why? Why try so hard to manage life when I could just put on a pair of glasses? No one would ever suggest a near-sighted person should just work harder. No one would say ‘Maybe that’s just your normal’ to someone who needs glasses. They would say ‘Let’s go to the eye doctor and get you a prescription so you’re able to see again.’ You shouldn’t have to try so hard.”

– My doctor (paraphrased), when I expressed doubts about going back on an anti-depressant. (via webreakthenwebuild)

(via squidilydink)

This is such a good analogy because nobody thinks about it like this. If you wear glasses, you literally need constant use of a medical aid to experience the world like most people do. If it were anything besides glasses, that would be considered a disability. But needing glasses is an extremely common, visible, and accepted form of disability to the point that we don’t even consider it one, we just accept that some people need glasses and that’s perfectly normal and there’s nothing wrong with needing to rely on them.

That is how all disabilities and illnesses should be seen, and how we should look at treatment for them. You have a problem, and you need help dealing with it, and there’s nothing wrong with either of those things. That’s perfectly normal and that’s okay.

(via ninjarobotclone)

And there are a couple more lines but forgive me I don’t feel like typing them out. The important parts are quoted above.

Putting aside the issues of for-profit pharmaceutical companies, our limited understanding of how certain drugs affect the brain, abuses in the mental illness management system, and that our society is so fucked up at least a quarter of us meet the criteria for mental health diagnoses while the rest are just plain miserable …

While we work on fixing that stuff: some of us need medication (and/or therapy) to function, just like some of us need glasses to see, and that’s okay. There should be no stigma associated with it, no shame in engaging in treatment, etc. When I finally get around to acquiring my next pair of glasses, I look forward to picking out frames I like and feel confident wearing. Similarly, it feels really good to own the work I’m doing in therapy and the medications I take: to be honest and unapologetic about what I need to not only live but (dare I say it?) thrive. It’s part of who I am, similar to how my glasses are part of my style (or look, hehe).

Of course I’m fortunate in that I have access to the care I need and communities where talking about one’s therapist, medication, and/or mental health is … if not normal, at least accepted. It’s understood that we’re all people and we all have our issues, we all struggle sometimes and we all need support. That shouldn’t be a matter of me being fortunate, though, it should be normal – like how acceptance of people wearing glasses is normal now, where once wearing glasses was stigmatized.

Learn more about being stigma free, and take the pledge.

Solidarity.

A New Normal?

According to the current clinical depression screening tool on MoodNetwork.org, I am not depressed. I was so surprised by this result when I first got it, I answered all the questions again to make sure I hadn’t lied on any of them: Sad most of the time, check. Trouble falling asleep and waking early, check. Feeling tired, check. All these other questions… no, my appetite hasn’t changed, I’m actually more motivated and active than usual, and I DON’T FEEL WORTHLESS!!! (or suicidal). I feel… okay.

a checkmark in a green circle next to the words, "You are not depressed."

screenshot of my result from the depression screening: a checkmark in a green circle next to the words, “You are not depressed.”

I’ve been re-taking the screening for the past few days now, and I keep getting the same result. I’m not depressed. I’m not depressed. I’m not depressed. I’M NOT DEPRESSED!!!

Oh my GOD!!!

I know, I know, it’s just an online screening. It’s not a substitute for a mental health professional’s evaluation. Well, I met with two mental health professionals this week. My prescriber told me, “It seems like your antidote to feeling sad is keeping busy.” She agreed with my decision to stay at my current dose of lamotrigine (50 mg 2x/day) because I don’t want to try to medicate away my feelings. Wakana congratulated me, said that clearly the therapy and medication are working, and told me I’ve been making good progress.

I am not depressed. Part of me wants to scream “I’m cured!!!” – but I think that might be a little bit premature. (or complete bullshit.) I’m… better. I’m okay.

I’m standing at the edge of a cliff with a brand new glider on my back, watching everyone else glide around, and wondering, “Is this thing really safe?”

Wakana said, “baby steps.” She used the metaphor of easing oneself slowly into a pool – which I find ironic because to me that’s torture. I’d rather just jump in, get the “it’s cold!” shock over with all at once, and start swimming oh my god swimming it’s the best thing ever!!! I want to go right now! But, umm, I don’t have a pool. So, yeah, this isn’t swimming it’s life. Baby steps. (I have friends who have a pool, and they’ve invited me to come swim in the past. I should ask them if the offer still stands.)

I guess I’m taking baby steps. I’m (literally) taking thousands of steps (that is, walking) on the days when I meet with her… and I want to take more on the days when I don’t. I’ve been having great conversations with loved ones, including Mom. Composing, making art for the fun of it, spoiling our pet rats… being intimate with Fox…  (I love having my sex drive back – and it takes some… navigating…) In the next few weeks I plan to acquire clothes I feel good about wearing, start practicing music instruments regularly, declutter, meet with my adviser about internship possibilities, and start applying for internships and part-time jobs. I had to re-write this paragraph to sound positive and not “being hard on myself” for the things I “should” be doing; now I’m worried about trying to do too much and burning out before I even get started! But at least I can re-write it.

In the past, times when I’ve temporarily clawed my way out of the bottomless pit that is being clinically depressed have been the best days of my life. For example, my wedding: at that time I was still using the Burns Depression Checklist to keep track of my symptoms; on my wedding day my score was 6. That’s “normal but unhappy” (granted, only 1 point off from “no depression”). The best I ever felt – EVER – the best days of my life were what most people would (ostensibly) consider “unhappy.”

These are not the best days of my life. I’m tired. I’m sad. I’m achy. I miss my friends, especially Banji. Last night I had a nightmare (in which my husband died). I’m going to go crazy (and spend way too much time playing The Sims 3) if I don’t find some way to structure my time (besides playing The Sims 3). For a while I was starting blog posts, then deleting them. … I think you get the idea.

Today I scored a 10 on the Burns Depression Checklist, which is the highest score in the “normal but unhappy” range. (a score of 11 would indicate mild depression.) I think I answered honestly, despite the temptation to lower my score to fit with the previous assertion that “I’m not depressed.” It seems accurate to say that I’m unhappy.

But something’s changed. Like someone lifted a blanket off me and I can see the sun and feel the breeze and stand up tall and breathe. I feel more confident. Hopeful. Maybe… even… whole?

Moody Monday: Feedback

The Mood Network is a research study that enables people with mood disorders and our family members to work with doctors and researchers to find better treatments – not only by providing data, but by sharing our insights. I first blogged about it 3 weeks ago, calling it an opportunity for activism, critiquing its implementation, and encouraging readers to “light a fire under the researchers’ butts.”

Well, some pretty awesome things have happened since then. I was contacted the next day by the head of the Mood Network: Dr. Andrew A. Nierenberg, MD. He thanked me for my feedback and assured me that he would bring my suggestions to the rest of the team. I’ll admit, I was a bit skeptical – but also pleased to have gotten his attention.

Then, on June 12th, Dr. Nierenberg commented on my first Moody Monday post:

Thanks so much for your interest and thoughtful comments about MoodNetwork.org. We are taking all of your feedback seriously and are in the process of implementing some of your suggestions. MoodNetwork will include surveys to do exactly what you suggest, i.e. to find out what is important to experts by experience. We will also have opportunities soon to not only to ask you and others about research priorities, but also will ask you about your experience in receiving care. We are also working on improving the forums and blogs – and yes, it does need a lot of love. Please be patient with us and thanks for joining.

It means a lot to me that the head of the Mood Network made a statement like that on a public site; it suggests to me that he and his team are serious about making those changes. I especially appreciate the specificity regarding which suggestions they intend to implement. (The new surveys and opportunities haven’t appeared yet.)

[Edit: there is a survey asking “what should we research?” The link to it appears in the menu on the mobile site, and in the left sidebar on the regular site.]

People have become a lot more active on the forums in the past few weeks. I’m enjoying the honest discussion, opportunities to see that others share some of my experiences and perspective (universality), and the feedback participants are providing about the site. If you are one of the active participants, thank you! (If you’ve joined or are considering joining, thank you!)

Most recently, two new categories have appeared on the forums: “Symptoms” and “Exercise.” I’m pleased to have more options, and very curious to see what people do with them.

Moody Monday

I’m reclassifying The Mood Network from “resource” to “opportunity for activism.” It’s a huge research project dedicated to developing better treatments for mood disorders based on the lived experiences of people who have them and our families. However, so far it looks more like a teaching model – “we’ll tell you” instead of “please tell us” – and the forums are practically dead. If this thing is going to work, it needs a lot of love.

Part of the "Participant Portal" page that becomes visible after signing in. Options include surveys to determine if you've ever had depression or mania, "ask the doctor," and discussion forums. Not visible: You can also read and comment on their blog.

Part of the “Participant Portal” page that becomes visible after signing in. Options include surveys to determine if you’ve ever had depression or mania, “ask the doctor,” and discussion forums. Not visible: You can also read and comment on their blog.

The Participant Portal, screenshot above, seems okay overall. I like the invitation to share our experiences. The forums and blog are the only places to do so, though. The surveys are similar to others you can find online, particularly at the Depression and Bipolar Support Alliance (one of the groups involved in this project.) I’m not sure if the “Ask the Doctor” option is unique among otherwise-available resources… But again it’s “ask the doctor” not “tell the doctor.”

I’ve been focusing on the forums the most and frankly, they are disheartening. A few people have gotten into discussing “Treatments,” but the “General Questions” forums are empty. I think the problem is that they create two mutually-exclusive categories that are ridiculously broad, unfocused, and don’t invite discussion of topics (or diagnoses) that may not fit neatly in either category. There is no way for participants to create new categories.

A screenshot of the "Forums" page. There are three categories: "Treatments," "General Questions about Depression," and "General Questions about Bipolar Disorder." Only the first category, "Treatments" has posts.

A screenshot of the “Forums” page. There are three categories: “Treatments,” “General Questions about Depression,” and “General Questions about Bipolar Disorder.” Only the first category, “Treatments” has posts.

I don’t know about other research participants, but I’m not there to ask questions; I’m there to share my experiences. Where is the space for us to share our stories? To discuss how mood disorders – and the associated stigma – impact our lives? To give feedback on our ability to access care and how health professionals treat us? Where is the space for our family members to discuss their experiences of living with and supporting us? What about those of us whose mental health issues don’t fit neatly into “Depression” or “Bipolar Disorder?”

One thing I’ve learned about research is that it’s important to come up with specific questions you want to answer via your research methodology. These researchers have created a space where they can ask us questions directly. They should use it! I can’t know what their questions are, but I can make some suggestions: “What makes a good therapist?” “What treatments have and haven’t worked for you?” “What barriers have you faced to accessing treatment?” “What can health professionals do to better meet your needs?” “What research do you think we should be doing?” Etc.

The words "Keep calm and formulate your research question" in gold against a red background

“Keep calm and formulate your research question” retrieved from the JEPS Bulletin.

Also, I’m annoyed that I had to choose “Male” or “Female” to register for the study. Gender (and physical sex) are so much more varied and complex than that! Trans* people face additional discrimination and erasure that definitely impact our mental health; those of us who are non-binary, fluid, agender, very proud of being trans*, etc. definitely don’t need more of that. Also, trans* people who transition medically may be taking hormones or have other unique medical needs that impact their response to medication and/or other treatments. These are all very important considerations for any health-related study.

Actually, that would be another great research question: “In what ways do systems of privilege and oppression (e.g. racism, sexism, cis- and/or heterosexism, wealth inequality, ableism, etc.) contribute to your mood disorder / symptoms?” I also like, “What community initiatives might help lower the incidence of mood disorders and/or make living with them easier?” Focusing on the medical aspect, “Do you have any medical condition(s) that have influenced the benefit you receive from treatment?” (I could probably do this all day.)

a masculine queer person, frowning and with arms crossed, is excluded from a conversation by other queer people taking place on the other side of a closed door

illustration by Jessica Krcmarik

Anyways, activism. I invite anyone who’s interested to join The Mood Network and light a fire under the researchers’ butts. Contact them directly with whatever feedback you deem appropriate, comment on their blog posts, start new discussions in the forums, send them links to mental health blogs. Spread the word. This is intended to help us, let’s make it our own!

This Post Took Three Days to Write

As I was crafting my last post, I came to understand why I was prioritizing a game over the mountains of important things (some of them very good) that are exploding in my life. It’s a defense mechanism.

I was suicidal last week – or, at least, the voices in my head were. It took everything I had just to pay attention in piano class last Thursday; thank the gods the instructor didn’t call on me to improvise in front of everyone!

Banji came over on Friday and helped me clean the area around my computer desk. I’m amazed by how much better I feel just being in this space now! It was really awesome of her … and it was also incredibly stressful for me. I kinda want to say maybe it wasn’t the best timing, but if I hadn’t done it then the clutter would have just kept making me increasingly miserable. It was the timing we had, so I’m glad we did it. I needed her support.

I visited with her family on Saturday. Her uncle was there; he kept criticizing her cousin and making passive-aggressive comments that were too subtle to respond to appropriately but could be devastating to a child’s self-esteem. I tried to ignore him, to connect with everyone else present, to enjoy our group activities… but it grated on me. Like a mosquito bite in a very awkward place. (It reminded me of how my mom has treated me, my own inner critic, and the cognitive distortions that make depression such a devastating illness.)

After they left, Banji and I were free to enjoy each other’s company. We played duets, sight-read my current composition project on a variety of instruments, and improvised on piano. The piano improvisation became incredibly silly, referencing inside jokes that are over a decade old. It felt so good to laugh with her, especially over shared experiences that helped form our relationship. It helped restore some of the sense of continuity I’ve been missing.

Then we moved to the couch and she decided I make an excellent pillow. We talked for hours. While I was holding her, everything felt right. My worries melted away. I felt whole, complete.

And I had hope for a future where little things like eating dinner together and playing duets and talking on the couch all night can happen whenever we both want them to.

Then Sunday came, and she had to drive home. For 5 hours.

I’m not suicidal anymore. I’m just sad. It’s going to take a lot of work to make our dream of living within a short drive of each other reality. (And even then, everything won’t magically be perfect.) A lot of it is outside our control. I have to include Fox in all my major decision-making. It’s big and scary and overwhelming.

Lately I’ve been trying to do too many things that are big and scary and overwhelming:

I’m re-taking 2 classes I had to drop 2 years ago because they were triggering my worst depression symptoms. In that time I was supposed to do useful things like find a medication that works for me and improve my music skills. Well, if Lamictal/lamotrigine has any chance of working, I need a much higher dose. The APN took me off it, then had me on 25 mg; I got frustrated and stopped taking it, then realized it seemed to help reduce my suicidal ideation so started taking it again yesterday… The point is I’m kind of starting over on it, I need to increase my dose gradually, and by the time I get any clinically significant benefit from it (or a different medication, if the APN puts me on one when I see her in three weeks) the semester will be over. I’m on my own. As for my music skills… they’re not as improved as I’d like, but I’m working on them. They’re serving me better than I’d expected (when I trust them).

The point is, these classes are challenging me in every way imaginable, but I just have to keep struggling through them. If I drop them again I might not be able to finish my degree.

Even if I do everything I need to, my school has a limit for how long you can take to graduate, and I’ve reached it. I’m at the mercy of a stranger who gets to decide whether I can have the extra time I’ll need to finish my degree. My recent experience of strangers making important decisions that affect my life has not been very good.

I’ve also re-structured my personality (in therapy) to the point where I have to change the way I interact with my mom. If I don’t, I’ll just continue doing unhealthy behaviors that ultimately hurt both of us. The ways I interact with my mom have been shaped my whole life to reduce the overt conflict between us and prevent her from abandoning me or falling apart emotionally or having to change the unhealthy behaviors she developed to adapt to live with her parents, etc. Changing them means risking the very things I’m programmed to avoid happening. I don’t always choose the best alternative behaviors, and she doesn’t always react well to them.

Based on our recent conversations, we’re both acutely aware of this and feel threatened by it. We’re afraid of… whatever comes next – but we also want the ways we’ve been relating to each other to change. I don’t know whether what each of us wants is compatible – or healthy. She won’t give me a straight answer when I ask her to join me in family therapy.

On top of this I’m (sort of?) coming out as non-binary. I’m in this really painful place where I’ve fully accepted it as my gender identity, but I’m not fully out to the people I interact with most regularly. They keep using the pronouns associated with my assigned gender; every time it happens it’s like a tiny stab in the heart. I don’t correct them because I’m not sure how to do so constructively. (And somehow it’s almost comforting because it’s familiar?!)

Worse, no one seemed to notice when Fox used my pronouns (in a shining moment of glory that filled me with joy) on Saturday. There was an almost imperceptible pause (that I might have imagined), and then the conversation continued as though nothing revolutionary had just happened. No one asked about the strange way he’d referred to me (“ze”). Their brains probably changed their perception of the phonemes to match their expectations.

Finally, my plan for this semester had been to join social groups on campus that might help me feel better about existing. My contact at counseling services has been respectful of my gender identity and tried to help me join a group that addresses some of my needs. But I just can’t stop thinking of it as yet another place to be misgendered! I feel like withdrawing into what’s safe and familiar, and where I know I can be perceived as I am… not reaching out into something new and scary.

The LGBTQ+ coming out group would probably be perfect… except that it’s a new social situation I’d have to adapt to. I imagine once the conversation started I’d either find it easy to participate, or get something out of listening to other people speak. But when it’s time to leave the house I feel anxious about entering a new, unpredictable social situation. I don’t feel like I can handle those at the moment.

I’m falling back, regrouping, re-prioritizing. This isn’t a matter of entertainment, personal growth, or self-actualization. It’s about survival. (Maybe my brain wouldn’t be in survival mode if my body were consistently getting the nutrients it needs…)

Anyway, priorities. The big 3: food, sleep, and physical activity. Let’s add emotional intimacy to that: hugs are amazingly comforting. Research across psychological disciplines consistently finds that the relationship between therapist and client is the most important part of therapy. Being emotionally available and supportive and non-judgmental heals, whatever the therapist’s orientation(s), modality(ies), and technique(s).

My mental health must be my first priority (followed by my physical health). Without that nothing else matters because I won’t be alive to enjoy it…

My classes come next; it’s very important that I pass both of them. Even if I don’t get the extension I need, I might be able to re-apply to the program and keep the credits I’ve already earned toward the degree – or transfer them to a new school if necessary. I’m so close to finishing, it’s painful.

The groups I wanted to join come last – possibly after video games. I thought they would help me to grow as a person, receive support for the issues I’ve been struggling with, and develop important skills I’ve been lacking … maybe even to make friends? I also decided at the beginning of the semester that it’s okay if I just need to focus on my classes right now. Making that decision – setting that boundary – is a way I can assert myself. That’s putting my hard work in therapy into action!

The nice thing about the LGBTQ+ groups is that they happen every week and I can show up when I’m ready to. I can make the decision of whether to go up to an hour before the group meets; my decision has no effect on whether I’ll be allowed to join in the following week. This week I decided not to go, but by the time one rolls around again I might be up to it. I’m thinking of calling and asking for a basic idea of how the time in group is structured, so it won’t be quite so unpredictable.

The counseling services group isn’t like that. It’s a specific 6-week course (complete with homework) and I’ve already missed the first week. I was invited to join in the second week (that is, today), but I’m feeling very ambivalent about it. On Tuesday I was wondering why I even wanted to be part of this group in the first place. By last night I was thinking maybe it would help me feel more confident and able to focus in my Thursday class (and more likely to go, because I’d already be on campus). The group closes after the second week, so if I miss it again I can’t join. I’ve been asked to let the facilitator know my decision ahead of time.

Perhaps it would be best to tell her I’ve decided against it. I already have a lot that I’m struggling with. I want to send in my own written appeal for periodontal treatment, I need to start working on the request for extended time in my academic program, I have instruments to practice, and I have papers to write. I’m counting primarily on the paper to get a halfway decent grade in piano class. If I don’t join this group, I’ll have more time and energy to dedicate to those things. I won’t have to deal with the social anxiety it’s bringing up. And I’ll have more time to recover from waking up before I have to coordinate getting ready to go somewhere with everything I need for the day, etc.

The main appeal of the group is that it’s an opportunity to practice yoga, meditate, learn ways to calm the nervous system, and cope with difficult emotions. I could do the yoga and meditation on my own … theoretically … but experience tells me I won’t. I need – and crave – structure and social support. I need to get outside my own head and receive feedback from someone other than my inner persecutor.

Just last night I had a great experience in my group music therapy class. I’d decided to show up, take notes, and role play for my group mates to the extent that I felt comfortable, but refuse to take a turn as therapist. Everyone else had taken their turn and I felt very shaken up, on the verge of tears. I felt raw, exposed; the muscles in my body tensed to the point where it felt like I couldn’t move. I sat very still for as long as I was able.

But the co-instructor came in and my group-mates told him I was the only one left who still needed to go. I couldn’t bring myself to come out as having a mood disorder, but I was as honest and vulnerable as possible: I said I’d been having a rough time and was feeling very raw and didn’t think I could lead a group in that emotional state. He asked if there was an experience I thought I could lead the group in, that might also help me to feel better.

I was going to do the intervention I’d come up with for my piano class, but sitting at the piano I had my back to the group and couldn’t find a practical way to remedy that. We were role-playing children, so my group-mates suggested I try a simple children’s song with two chords and play on guitar. I agreed to a song someone suggested, and the next thing I knew I was playing guitar fairly fluently, singing, using the song structure to maintain order while allowing the “kids” to be spontaneous and creative and interact with each other, and having fun. I was even able to take constructive criticism and try some of the suggestions that were offered.

I learned so much from that experience and felt so much better afterward … because I was present and vulnerable with others; I allowed them to support me. And they did. They were awesome! They gave me the push I needed to succeed.

I was hoping to have a similar experience with the counseling services group. We’d all be there to learn to overcome certain insecurities and practice new ways of being with ourselves and others. If I didn’t feel like it’s helping me, I could always drop out. Short of dropping out, I could decide the degree to which I want to participate (including whether to do the homework). It’s only five weeks. I might have made new friends, or at least learned something useful…

… But then I talked to my contact at counseling services, and she suggested I “put it on hold” so I can “focus on stabilizing my depression.” She seems to think it’s not really the kind of group I need right now. Perhaps I can try it in the fall.

I feel empty, deflated, tired, and maybe just a little bit relieved. and thirsty. Maybe I’ll just sit here. Indefinitely.