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Author Topic: Medication Issue  (Read 946 times)
Akita
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« on: June 02, 2016, 12:59:35 PM »

My BPD wife has been instructed by her therapist (psychologist) to seek a medication evaluation with a psychiatrist.  Previously she was on medication and being monitored by a PA housed in the same complex as her psychologist.  He decided she was out of his realm of expertise.  At least that is the reason they are telling her for no longer helping her with medication.  Yes she struggled with using the recommended dose and yes she ended the medication on her own and refused to work with the PA.  She could tell by how he treated her that he didn't like her so she was no longer comfortable working with him.  She tried to get her case picked up by the other PA or the psychiatrist in the complex.  After they had a meeting and discussed her case with her original PA none of them wanted to take her case.  She is very hurt by this.  She has anxiety and doesn't want to go to a new facility with new people.  Her psychologist told her being on medication was her choice.  He has no started pushing the issue.  Claims he sees her situation clearer now and he needs her on medication.  She tried to set an appointment with a person in his complex even though they originally said no.  Apparently the front desk was unaware and made her an appointment with a different PA.  Later it was discovered and she was again told she could not see that person.  This was another upsetting issue.  She is having a hard time understanding why no one wants to help her in her psychologists office.  He just tells her it is out of their control and they need to move forward with other options.  This brings me to the current issue.  The psychologist has now told her she must make an appointment and keep it or he will no longer be able to help her.  She sees this as very unfair.  She sees this as lying.  She sees this as blackmail.  She is suppose to be able to give him a date by next Wednesday.  If she can't he will not schedule an appointment with her until she has a set date.  This news came at the end of her appointment and overwhelmed her.  She left the office without making an appointment with the psychologist for next week.  She has written him two notes she snail mailed to him discussing this issue, they totaled 5 pages.  She doesn't know how to solve this impasse.  She doesn't feel listened to.  How can I help her?  
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« Reply #1 on: June 03, 2016, 08:27:57 AM »

This is very unfortunate to hear. Your wife is trying to get the help she so desperatley needs and is being denied. How frustrating smh. My cousin who has a PhD in psychology says that BPD patients are often treated this way and are avoided and even cut off by many professionals. Seeking a therapist who is trained in dialectical behavior therapy (dbt) will really help her. My cousin said that is the best treatment for Bpd.

Currently my pwBPD is not in therapy but we practice alot of the skills on our own. We also both take natural supplements to improve our moods. And we both have chosen to live sober lives.

But see if you can find a therapist in your area who specializes in DBT. It's the best therapy for BPD.
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Akita
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« Reply #2 on: June 03, 2016, 02:42:49 PM »

She disliked DBT and stopped seeing that therapist.  Her current therapist is doing a bit of everything with her to see what works best her.
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« Reply #3 on: June 04, 2016, 09:54:48 PM »

Rats! Did she share with you what she didn't like about dbt specifically?
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« Reply #4 on: June 05, 2016, 12:27:05 AM »

The problem with BPD is that if they are seeing someone who is not particularly specialized in this area it can make things worse and even more frustrating. It is better a T says no if they believe they can't make progress.

Cancelling appointments is common with BPD clients, and Ts know this and so are often strict.

A pwBPD will often accuse the "system" of singling them out and treating them badly. Often pwBPD seek out a therapist who is more of a shoulder to dry on rather than one who makes them face harsh realities, hence they can gravitate towards that give an easy ride, but no ultimate progress.
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Akita
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« Reply #5 on: June 05, 2016, 01:29:59 AM »

She said the DBT skills were weak compared with her self harm methods.  Felt the therapist was no longer trying to help her.  She is having doubts about her current therapist.  I told her the ultimatum might be good for her as she is in her comfort zone and she won't be able to change unless she gets out of her comfort zone.  She dislikes this and still feels pressured and manipulated.  She says she will consider this but is nervous about caving in to these tactics because she doesn't know what he'll ask of her in the future.  The whole scenario makes her in comfortable. 
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« Reply #6 on: June 05, 2016, 07:40:53 AM »

I is possible that the group your wife was seeing does not feel comfortable continuing to prescribe medication for a patient who is not compliant with them.

There is something important to consider in this statement:

Yes she struggled with using the recommended dose and yes she ended the medication on her own and refused to work with the PA. She could tell by how he treated her that he didn't like her so she was no longer comfortable working with him.

She sees this as very unfair.  She sees this as lying.  She sees this as blackmail.


Your wife is taking "victim" perspective. The victim of the unfair mean PA who doesn't like her. This does not take into consideration that her non compliance plays a crucial part in the decision to not treat her. Health care providers can refer a patient to someone else in this situation.

What she is doing is the same as if she went to get treated for an infection, was given antibiotics, didn't take them correctly and then complains that the PA who gave them to her doesn't like her. After trying as many times as he can, the PA says " well I have tried all I can and you still have this infection, so I am sending you to a specialist to see if there is more that can be done to help you".

This is the opposite of what your wife is claiming. She is not their victim. They have done what they can do to help her and now, they feel they need to refer her to someone who may be able to help her. By doing so, they are trying to get her the best help possible. They are not the problem. She is. She is not cooperating with them.

So, you want to help her but if you collude with her over her stance as "victim" then you are enabling her, and also enabling her to make any treatment not effective by her own non-compliance.

She has choices here. If she wants to get better, then she can choose to cooperate with her health care practitioners. But nobody can force her.  

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« Reply #7 on: June 05, 2016, 08:29:12 AM »

This is a difficult situation to see sometimes. I know you love your wife and want to help her. My father loved my BPD mother too, he would have done anything to help her, and he did.

He is deceased. Some time afterwards she was admitted to the hospital for psychiatric issues. This is something I thought was long needed, but it would not likely have happened as my father would not want her to face the discomfort as well as the embarrassment of being exposed.

He would have intervened. My mother complained about how awful it was, what a terrible place it was, and so on. He would have either not let her go there or gone to pick her up the moment she called him to tell him it was terrible.

Yet, I don't have too much high hopes for progress as when she explained it to me, she blamed the doctor. Said she didn't belong in this place and has refused to return for follow up. It's all their fault. It would be tempting to believe her but think this is what is exactly what she needs to get help- if she would comply with it. However, I don't have hopes for much since her focus was on what they did to her, not what she wants to do to get better.

It sounds harsh, but sometimes letting your wife face the consequences of her not cooperating with her health care workers may get her to get help sooner. As much as you want to protect her from discomfort, you may be making it harder for her to get help in the long run.
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« Reply #8 on: June 05, 2016, 11:11:22 AM »

They r basically forcing her to get evaluated or they won't provide her psychotherapy.  Is that fair?  Because she won't do one thing they can just cut her out?  So instead of getting psychotherapy she gets nothing?  She doesn't want to be on medication, hates the thought of needing pills to make her "normal".  Why doesn't her opinion count?  She use to see him twice a week but he dropped her to once a week after she got angry and misused their message system.  He had cancelled two appointments and she felt he was just cancelling hers.  So she cancelled all her preset appointments and sent an angry message.  He called her unsettled and thought they needed to reestablish what therapy was for her.  She doesn't feel any better or more clear about her treatment plan.  She feels punished and disliked.  She says he is doing this as a way to drop her by making it her fault so he won't have to feel guilty about not seeing her.
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« Reply #9 on: June 05, 2016, 08:33:30 PM »

They r basically forcing her to get evaluated or they won't provide her psychotherapy.  Is that fair? 

What they have been doing so far is clearly not working. So to move forward they need a clear plan, to have a clear plan you need a clear assessment. So without an assessment things continue to go around in circles. This requires patient co operation, which seems to be a sticking point at the moment.

An assessment may very well indicate that medications would be of no measurable benefit, which is often the case with BPD. They can take the edge of things like depression, anxiety and mood swings, but sometimes they have little effect, or even negative side affects. That is an unknown without an assessment.

If there is a conflict of personalities then nothing is going to work anyway, hence an assessment by someone fresh may be necessary.

  She feels punished and disliked.  She says he is doing this as a way to drop her by making it her fault so he won't have to feel guilty about not seeing her.

She is projecting her way of reasoning on to him. It is possible that he is calling a halt to an obvious downward spiral, which is occurring for unknown reasons. An assessment is required to find out this reason, even if it is just a personality clash.

I have seen this process you describe over and over, and there is only one common factor and that is the pwBPD. That is the nature of BPD, whether it be with health professionals, work colleagues or family and friends it is the same pattern.
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« Reply #10 on: June 05, 2016, 08:46:11 PM »

So the psychologist is in the right?  It's reasonable to use the assessment as a means to not see her if she won't do it?  Isn't there a more reasonable way to handle the present situation?
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« Reply #11 on: June 05, 2016, 10:20:44 PM »

So the psychologist is in the right?  It's reasonable to use the assessment as a means to not see her if she won't do it?  Isn't there a more reasonable way to handle the present situation?

That is the psychologists boundary. boundaries are not about fairness they are about stopping someone from going where they are uncomfortable to be. The psychologist most likely thinks nothing will change without a a change, and that the present direction is getting nowhere.

If there is an outright clash in personalities then your wife may need to see someone else. pwBPD do struggle with personality clashes.
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« Reply #12 on: June 05, 2016, 10:25:43 PM »

Some of the boundaries may also be "built in" for the psychologists--in the form of professional codes of ethics and responsibilities.
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« Reply #13 on: June 06, 2016, 02:13:51 AM »

So what's the solution?  What do I do?
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« Reply #14 on: June 06, 2016, 06:48:15 AM »

So what's the solution?  What do I do?

She has choices, either attend the given appointment, seek help elsewhere or do nothing. By making a choice she moves out of victim mode. Victim mode is a result of not making choices.

What do you do? You allow her to make her choice and support it whatever it may be. You do not push her one way or the other as that just adds pressure.

Quitting therapy due to feeling overwhelmed/pressured/helpless is common. That is not the end of the road, there are many blind alleys. It can always be reapproached again in the future with a fresh mind and fresh resources.  It is a fine balance between being outside the comfort zone and going so far that it completely undermines someone.
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« Reply #15 on: June 06, 2016, 08:22:07 AM »

It isn't about being fair or not, but about the health care team having the information they need to provide the best treatment. To do this, they want an evaluation. They don't treat without this because they want to do the best thing and they need information to do so.

Yes your wife has a say in this. She can decide to do it her way, whatever that is. The reason we consult professionals is because we are not experts and want them to help. This isn't just for medicine. If you were having financial problems - and a financial adviser said "I need to see all your bank statements and tax forms so that I can see where to help you" and you refused, then the advisor can say " I can't help you"

What do you do? If your wife is capable of consenting to the health care plan- then she is legally allowed to make that decision or not. Even if it is a decision you don't a agree with. Her health care providers have told her what they need in order to treat her. Now she can decide.

It isn't personal or being fair or unfair. BPD can influence this kind of reasoning. You have th choice of aligning with her view that this is unfair to her, or looking at this from the perspective that this is what they feel they need in order to help her- while also validating your wife's feelings of being scared, angry, hurt.
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Akita
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« Reply #16 on: June 06, 2016, 10:19:16 AM »

My position is that what he is doing is a last resort for him to help her.  She has high anxiety over going to a new place.  She didn't mean to burn her bridges with the PA.  She was really frustrated by their lack of communication with her about the medicine.  She felt it was doing nothing so she adjusted the dose herself.  Then they wanted to really up her dose which would have required some heart monitoring.  This really freaked her out so she abruptly stopped and informed them she would no longer be needing medication.  I don't know how to help her see that it is worth the anxiety and risk she feels she is taking.  She is very disagreeable to the scenario the psychologist has created.  She thinks it's unnecessary and wonders why he won't listen to her feelings on the subject.  She wrote him 5 pages worth of how she felt about it and hasn't received a response from him.  She feels this is just more of him ignoring her perspective on the medication issue.  What would validation look like in this situation?  I don't think anyone truly grasps how this is affecting her.  She doesn't want to switch psychologists again.  This is the 4th person she has spoken to about her struggles and she doesn't feel like she can share and start over again.  This is one reason she doesn't want a medication evaluation.  She is going to have to share details about herself she doesn't like sharing.  She just wants this situation to go away.
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« Reply #17 on: June 06, 2016, 06:43:48 PM »

Validation is understanding and listening to her concerns. Not giving opinions on who is right or wrong, otherwise you fall into the trap of validating the invalid.

At the moment her reactions are sitting at an extreme black or white level of thinking.

Maybe to defer some time out from therapy is required until the immediacy of her defensiveness has lowered. Then she can make her choices. Odds are if she eventually goes with the therapists plan then it wont be as extreme as she is believing it will be.

Reducing the current state of agitation is probably the most important thing at the moment.

As previously stated your wifes reaction to this is quite common, and I have not doubt the psychologists have experienced this many times before, and as wendy states they probably have established procedures for situations like this born out of experioence.
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« Reply #18 on: June 06, 2016, 10:39:51 PM »

How can I help her process the decision she needs to make?  She doesn't seem to know how to resolve this.
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« Reply #19 on: June 07, 2016, 07:44:06 AM »

I don't think you can help fix her feelings about the situation - they are hers to deal with. Also, this conflict is between her and the health care providers. They have made their requirement clear- the evaluation. While your wife fears it is about medication-it might not be just that- but to try to get more information so they can help her. It's uncomfortable to disclose personal issues but that may be information they need. They can't help someone who won't cooperate with them-that goes for any professional.

Although your wife wants this to be gone on its own-she has choices too. Cooperate with the evaluation- or not. This doesn't mean being forced to take medicine- she has a say about that but she needs to communicate with them-not just make changes on her own.

If she is not sure what the evaluation is about -she can ask them.

Although it's not easy to see her struggle-this is her relationship with her health care providers and the choice of what to do is up to her. You can be emotionally supportive but let her work with this.
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« Reply #20 on: June 07, 2016, 10:18:18 AM »

What would you all say or how would you approach your BPD in this situation?  She has asked for my help.  Asking for help is not a natural thing for her, she hates it as it makes her feel like a lesser person and incompetent.
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« Reply #21 on: June 08, 2016, 07:59:42 AM »

I think it is important to know what kind of help she is asking for. If it is to make the bad feelings, or the situation "go away" then that isn't helping. If it is to help her get medical care, then you may be able to help, but there is also the risk of drama.

Is this triangulation " help save me from the bad doctor/PA/". If you take the perspective of the PA, then you are "against her". She is perceiving herself as the "victim" here. If you step in as rescuer, then you are part of the drama. If you side with the PA, then you are the persecutor.

What would I do? I would feel that there isn't much I can do because either way- helping "fix" the situation or agreeing with the PA would be drama. Your wife is at least part of this problem because she didn't cooperate with them.

I think you can validate her feelings and support her ability to choose. This is important- she asked for help but supporting her that she can make this choice rather than fixing this for her may be more helpful even if she doesn't like it.

I can imagine something like this: Honey, I understand this is difficult here and you asked for my help. I think there are two main choices here. If you want to stay with this PA - then you will need to do the evaluation. But you also have the choice to not do it, and or find another doctor/PA. I can't choose for you- as the main relationship is between you and the doctor. You may not know what do do now and it is OK to think about it if you need to. I love you and can be here for you for moral support- as you go through the evaluation or see someone else.
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« Reply #22 on: June 08, 2016, 12:00:41 PM »

i don't understand how u can say I'm part of the problem.  I'm HAVING a problem.  ... .my psychologist and the medication ppl at his office are the problem.  I AM a victim... .they can just demand whatever they want and use underhanded ways to make me comply if I don't comply they drop me!  It's not good enough for them to just give me the treatment I'm comfortable with o they need to force medication. He told me medication was my choice and now suddenly it's do this or i won't  seeing you anymore!  If this was a different type of medical need I'm re the provider would be more willing to listen to the patient if the patient was uncomfortable with a portion of the treatment plan the provider would come up with other solutions not just throw the patient under the bus and say do this or im done with u and u can just go find someone else to help u!  No one treats patients like that!  The only reason this is happening to me is because it's MENTAL illness so ppl can just do whatever they want to me and I'm supposed to realize oh it's for my own good oh I'm not normal mentally so i just need to do whatever they f***ing say because I'm  too f***ed up to know what is best for me or what im comfortable having happen to me but no my thoughts don't matter because I'm borderline!  This is not me being part of the problem this is them mistreating me because of my MENTAL diagnosis.  This is not how ppl should be treated!  How is this okay?  Imagine if your dr was forcing something on YOU or they wouldn't see you again!does that feel right to u... .does that feel normal like a typical way a dr would interact with a patient!  I doubt it.  Ppl just try to take advantage and it's not right.[/font

Wendy, I had my dBPDw read your post to see how she felt about it and to see if it would help her understand my perspective as you put my thought in to words so well.  As you can see she still doesn't feel like anyone understands what is happening to her.  After seeing her psychologist yesterday she has decided to call for the evaluation.  She still very much feels like unethical tactics were used to force her choice.  She is extremely upset and resentful.  I was hoping reading your post would open her eyes to her role.  She didn't see it that way at all .  I'm not sure what to do from here.  Can I reduce her feelings of anger and resentment?  Should I continue to try to help her understand the situation from the psychologist's perspective?  Or do I leave it alone?
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« Reply #23 on: June 08, 2016, 12:25:35 PM »

How do I respond to her when this is how she explains herself?
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« Reply #24 on: June 08, 2016, 03:58:51 PM »

How do I respond to her when this is how she explains herself?

You dont have to, otherwise you are going into JADE (Justify, Argue, Explain, Defend) by proxy, on behalf of the system. As wendy says, if you do then you are in danger of being "as bad as them" and joining the persecutor team.

You have listened to her and clarified her options, whether she likes them or not. You have shown empathy as to how it must feel to be uncomfortable with these options. The reality is she has to make some kind of choice. That is the basis of SET (Support, Empathy and Truth). You cant fix her ill feelings for her.

If you take sides and agree they are wrong and she is right then there is a good chance you could reinforce the mindset of proving the system wrong thus reducing the level of willing co operation, hence sabotaging any progress.
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« Reply #25 on: June 08, 2016, 04:41:30 PM »

Waverider

This afternoon she called the other provider.  She is still angry over the entire situation but she doesn't want to start over with all new people.  If he uses this ultimatum strategy again she is likely to completely quit therapy.  She can't take anymore of being treated this way.  She says he made some relevant points to the benefits of medication, she also did some online research on BPD and medication.  Anyway she called and they didn't have a referral for her so she didn't know who to make an appointment with.  She hung up and called her psychologist's office.  The psychologist's office not only resent the referral but they also scheduled the appointment for her.  The psychologist's office called my dBPDw back and confirmed the appointment at the new provider to make sure she could go at that time.  They also told her they informed the new provider what was going on with her.  My question is did the psychologist's office over step their bounds?  So now she didn't actually make the appointment herself like they stressed to her.  She was all smiles getting off the phone with the psychologist's office, she felt taken care of and praised the office girl who helped her. 
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« Reply #26 on: June 08, 2016, 05:49:19 PM »

She is also wondering if this was appropriate.  She is worried about what they told the new provider and who did the telling, the front office or her psychologist.  Plus she is annoyed that they didn't just make the appointment for her in the first place.  How can I help calm all these thoughts?
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« Reply #27 on: June 08, 2016, 11:16:54 PM »

Its only the same as passing on medical records. Dont see too much issue with making the appointment. Asking her to make it in the first instance i sjust simpler, there was just a glitch so they helped it along a bit

I think there is a touch of paranoia creeping in. Original practice is not out to stitch her up. The provider needs to know what the purpose of the appointment is.

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« Reply #28 on: June 09, 2016, 12:11:00 AM »

What do you mean " out to stitch her up"?
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« Reply #29 on: June 09, 2016, 12:18:52 AM »

What do you mean " out to stitch her up"?

There is no conspiracy to not do the best thing for her.
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