Author Interview: How to Find Healing with a Mental Illness

      “Often it's deepest pain which empowers you to grow into your higher self." -Karen Salmansohn 

Dorit Sasson of Giving Voice to Your Courage reached out to me to learn more about the courage it took to write about the twenty-year patient-psychiatrist collaboration in my groundbreaking book Finding My Voice and the road towards recovery from disability to full-time employment. I'd love to know what you think of this post - feel free to share this post and post your comments below. 

Thank you Dorit!

      Dorit Sasson: First and foremost, let's start with your book "Finding My Voice." There's right now a lot of public awareness around the importance of telling one's story to help educate the public on mental illness. What kind of experience or work did you have to do to give the writing of this book justice? 

     

      

      Tova Feinman: Although this book details the severe mental illness and childhood trauma I suffer with, it is actually a story about the healing power of the clinical relationship between psychiatrist and patient. 

      It’s a relationship story about trust, bonding, faith, and the transformation that results when all these elements of healing work in concert. This book is less “my story” and more the common denominator in the story of clinically guided healing. What does make my journey unique is the fact that it’s not unique. This is what good psychiatric care looks like and how it succeeds. 

      Any patient who has found recovery in treatment could tell a similar story. Unfortunately, far too few do. I want to see more successful clinical journeys shared. There is no shortage of stories about illness. There is a dearth of stories about the mechanism by which illness becomes recovery. 

      DS: This book describes a twenty-year period of collaboration of healing between yourself as a mentally ill patient and Dr. Rosen. As an author, were you aware of how important it was for you to give voice to the healing part of this book? Do you think you achieved even deeper healing beyond the level of care, as an author? 

TF: Healing is an ongoing process. Certainly, the art of sifting through twenty-two years of mental health care to distill out essential events and facts fostered further growth. I made the comment to Dr. Rosen when I said, “I don’t write about what still hurts.” 

The ah-ha moment for me as I wrote this book happened when I realized just how much of my life and past no longer hurt. I truly am healing and this transformation could not have occurred without solid clinical care.

        DS: How easy or hard was it for you to tell your story? 

        

        TF: Sifting through 22 years of clinical experiences to reach the key nuggets of detail wasn't difficult. Making the decision that those details should be made public was difficult. Losing the cloak of anonymity was even more difficult. Accepting that you are making yourself vulnerable to total strangers was the most difficult. However, if you have a message worth sharing, you take the risk.

      DS: How is being a mental health patient different than telling your story? What ingredients do you need to make this experience successful?

      

      TF: I am many things. I’m a mom, a writer, a scientist, a friend, and a compassionate human being. I am also a woman who lives 24/7 with illnesses that need continued treatment.  The odyssey chronicled in this book is the treatment component of my life. 

     

Treatment is integrated into every other aspect of my existence. There is no separation. If by “making the experience successful” you mean the writing experience, the simple answer is you need to be fearlessly honest with yourself. I am neither heroine nor villain. I’m a flawed human being with mountains that needed to be scaled if I was going to have any chance at a “normal” life. Without good clinical care, I could never have scaled those mountains.

      DS: Since I'm a big believer in courage, I suspect that it took a great deal of courage to tell this story and now, to educate people on this book. How do you see the journey of courage as it affects you as the writer now turned author?

      TF: I believe courage begins when we face our own demons. Not just the demons inflicted on us by others but those aspects of ourselves that we would rather hide in order to save face. Talking about being victimized is easier than talking about how we victimized. Owning one’s imperfections and the role those imperfections play in acerbating our own suffering is where courage really shines. Throughout the book I carefully balanced being a victim with at times being, albeit often inadvertently, someone who caused pain. I’m neither saint nor devil. I am flawed and I constantly strive for redemption. Illustrating that takes courage.

      DS: What do you see as some of the challenges in the way people are evaluating as their mental health care options? How do you see your book as an important link to that process of getting good mental health care? 

TF: A critical motivator for writing this book was to reach out to fellow patients who are struggling in their clinical relationships and wondering when their healing comes. My message throughout this book is that the more we patients empower ourselves in our clinical relationships the closer we move toward a healing partnership. The more actively we join our own treatment team, the closer we move to transformation. 

We, patients, make a terrible mistake if we see ourselves as empty vessels waiting for the wisdom of the MD to pour healing into us. That isn’t where the genius of the psychiatrist-patient healing lays. It lays in collaboration, cooperation, and communication between MD and patient. 

The single greatest lesson I learned in 20 years with Dr. Rosen is that I’m as much responsible for my clinical outcome as he is. If this is the only take-away people get from my book, I will have accomplished my goal.

Therapeutic Relationship Killers: What to Do if Your Psychiatrist is Having a Bad Day

Your psychiatrist or psychotherapist is having a bad day and you catch them on their bad day. What do you do?

Some truths:

•  You have bad days, I have bad days. Every human on earth has off days. That includes your psychiatrist and psychotherapist.
• Only Dr. Sydney Freedman has perfect clinical days all the time. The biggest killer is unrealistic expectations but the good news is that it's possible to work through these expectations with your psychiatrist. 
• Most psychiatrists and psychotherapists are not going to admit to you they aren’t at their best. This is important. 
• You are definitely going to notice that they are behaving out-of-the-ordinary for your relationship
• You are very likely going to negative mind read their behavior. It’s hard not to

Signs your psychiatrist/psychotherapist is having a bad day:

• They aren’t listening in their normal attentive style
• Their responses feel hurtful or not carefully considered, also not the norm for them
• They are distracted and usually, they pay attention
• You feel like they are rushing you. They are uncharacteristically not letting you think through what they are saying and not letting you respond

So, what should you do?

• Give them the benefit of the doubt. If they have a consistent track record and they are off one session, let them be human.
• Don’t own their off day. It’s not about you. Maybe they just handled 3 emergency calls or maybe their dog died. You don’t know.
• If you have a really comfortable relationship you can ask something like, “You seem distracted to me.” See where the conversation goes.
• If you are not in a really comfortable relationship, find a way to communicate your feelings to him in less threatening ways.

1.Try a letter or e-mail. I illustrate this in a number of examples in my upcoming book Finding My Voice: A 20 Year Patient-Psychiatrist Journey

2.Leave a voicemail message on his office answering machine

3.Address it at your next session when he’s back to his old self.

4.Always be respectful, and you’ll get a more meaningful response.

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     It’s really hard in these circumstances but don’t jump to negative mind reading. It only hurts YOU and damages your relationship with him.

In My Perfect Therapeutic World

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      Psychiatrists and psychotherapists would give their patients up front permission to ask if they feel something is amiss in a session.

    Patients would take them up on that invitation and ask.

1.My standard line with Dr. Rosen in my book Finding My Voice is: “You seem a trifle cranky today.” That usually precipitates a longer, more helpful discussion.

2.Find a statement that feels safe to you that you can try on him the next time you encounter a Bad Day Syndrome.

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     Patients would be understanding of their psychiatrist’s humanness and not let his bad day become their bad day.

Next relationship killer to tackle: what do you do if your psychiatrist or psychotherapist makes a mistake with your care. I’ll use two examples from my own experience to illustrate.

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Are You Suffering from Negative Mindreading?

Negative Mindreading means you know for sure what your MD believes about you, and you've decided he's an indifferent fiend who hates you and doesn't care about your suffering. 

It's hard enough to deal with mental illness without creating misery from our imaginations. 

My psychologist Lynn coined the term "negative mindreading" to describe a particular way patients have of negatively personalizing their clinician’s insights.

Here’s a scene from my own treatment:

Dr. Rosen: “You look like you are really doing well”

Shoshana: “Actually, I’ve been having a really hard time with nightmares”

Dr. Rosen: “Nightmares aren’t new for you, are you taking your medication?”

Shoshana: “Yes, but it’s not helping”

Dr. Rosen: “The nightmares may pass, they often do. Just stay on your medication.”

Here’s my negative mindreading:

• ·       He doesn’t care about my nightmares
• ·        I don’t matter to him
• ·        He hates me

What happens after negative mindreading? 

Well if you are like a lot of patients with mental illness you go to the internet and complain to everyone that your psychiatrist is an insensitive jerk who doesn’t care about your suffering. You don’t go to your MD and ask HIM if you are interpreting his insights correctly.

Here’s a better approach for the next appointment:

Shoshana: “Can we talk about ways of curbing my nightmares. We didn’t really address them last appointment”

Dr. Rosen: “They haven’t subsided?”

Shoshana: “No, and last appointment I thought you didn’t care about them”

Dr. Rosen: “I wanted to see if the problem would resolve spontaneously before we discussed treatment. Since that hasn’t happened, let’s try adjusting your Seroquel dose.”

Takeaways from my example:

·        Dr. Rosen wasn’t indifferent to my problem

·        He had a strategy

·        He doesn’t hate me

·        Delete all those comments I made on-line about him being an insensitive jerk (I never really posted that but many patients do)

Consequences of Negative Mindreading

• ·        You make yourself miserable
• ·        You are more often than not WRONG in your assessment
• ·        You make it difficult for your MD or therapist to help you because you convince yourself they don’t care about you

Conclusion: Ask your MD if you feel he doesn’t care, isn’t listening, or hates you. You’ll save yourself a lot of grief and you won’t post stupid stuff online.

Next Up! Relationship Killers Part 3 - Forgetting your MD is a human being. This is a touchy topic for patients and physicians. Heaven forbid he’s having a bad day and you happen to have an appointment during his bad day. We’ll discuss.

Have you ever had to deal with any of these relationship killers? If so, how did you deal with them?

Clinical Relationship Killers (Part 1)

Unrealistic Expectations, the Extremes

So, you expect your psychiatrist to be M*A*S*H’s Dr. Sydney Freedman’s identical twin? Remember the character?

Dr. Freedman’s god-like Clinical Skills

• A fountain of unrivaled clinical insight
• An unfailingly compassionate listener
• Infinitely intuitive
• Perfect couch-side manner
• Witty

Let me break it to you gently. Your psychiatrist is not Sydney Freedman. In fact, no psychiatrist is. Dr. Sydney Freedman is a unicorn. He doesn’t exist. Unions are perfect and imaginary. Sydney Freeman is perfect and imaginary. I wonder how many people left treatment because their very human psychiatrist didn’t measure up to an ideal.

The opposite extreme to the good Dr. Freedman, Hannibal Lecter:

Hannibal’s Satanic Clinical Skills

• He’s a sociopath
• He’s a serial killer
• He’s a cannibal

Let me reassure you. Your psychiatrist isn’t a serial killer and he doesn’t want to have you as a meal. 

Dr. Lecter is a fictional character designed to scare the daylights out of movie audiences. I wonder how many people decided not to seek needed treatment because their darkest irrational suspicions about psychiatrists were given a face.

Taming expectations is crucial.

Real-World Psychiatry

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          Some psychiatrists are truly gifted. Just as some orthopedists and family physicians are. If you are the patient of a truly gifted MD, treasure him or her.

•      Remember however, that gifted doesn’t mean Dr. Sydney Freedman.
•      Most psychiatrists are in the “mushy middle.”
•      If you find yourself dissatisfied with aspects of your Dr.-patient relationship, the growth potential for you is huge.
•      Working through your dissatisfaction with him will reap enormous clinical benefits for you.
•     I will explore at great length in future blog posts various dissatisfaction we patients have and strategies for working through those complaints with our MDs.
•     Don’t bail on a “mushy middle” clinical relationship. Work through the conflicts.     
• 
  

My book Finding My Voice: A 20-Year Psychiatrist-Patient Odyssey is about resolving clinical struggles and creating transformation. I know this subject well.

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 A few psychiatrists should be in the lab, not with patients. Every field of medicine has those rare practitioners who should be doing something else. Psychiatry is no exception.

•     Make every attempt to work through the conflicts with your physician.
•     Seek assistance from your psychotherapist. She can intervene on your behalf
•     If there is no resolution, get a second referral.
•     Don’t stay in an unhealthy or destructive clinical relationship with any physician or psychotherapist
•     Fortunately, this is an uncommon occurrence

The next “Relationship Killer” post will be on “negative mindreading” or the tendency for those of us in treatment to presuppose our clinicians’ meaning or intent. A lot of needless injury is caused by assuming the worst about a clinical insight your psychiatrist or psychotherapist has shared with you. Negative mindreading is a trap to be worked through and avoided.

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Preparing for Your First Psychiatrist Appointment

In the previous blog posts, I walked you through the strategy of finding your psychiatrist. Now what happens? First, check-in with yourself. Are you anxious or afraid of this upcoming appointment? Preparation is power. Take that power; don't give it away for ultimately, your psychiatrist wants to help you heal. 

The Basics

• Make sure you have good directions to his office. Getting lost stinks on your first day.
• Call his office in advance and ask the office manager about parking availability or bus line access
• Remember your insurance card and copay. Ask the office manager what copay method is accepted. Surprises on your first appointment are anxiety-producing
• Make an outline of the essential pieces of information you want the MD to know. Write them down. If you get nervous, sometimes remembering what you want to say can be a challenge.
• Arrive at least 15 minutes early. Not just because of paperwork but also because it gives you time to collect your thoughts and get familiar with his waiting room. The first thing I noticed about Dr. Rosen’s waiting room was his artwork. Finding something to focus on in a new environment that’s calming is a big plus. Review your notes for the appointment. Ground yourself with the reasons you are there. This is your big WHY.

• Most psychiatrist appointments run pretty much on schedule, barring emergencies. If you show up too late you will have to reschedule. Not what you want on your first appointment.
• Remember, he’s in this branch of medicine to help people struggling with mental illnesses. He’s not going to judge you. 

What You Can Expect at Your First Appointment

• Your psychiatrist will greet you and usher you into his office.
• He’ll introduce himself and ask how he can help you
• Get out that piece of paper that has your main concerns on them. Share your list with him.
• He’ll ask you lots of questions about your life experiences, background, how you spend your time, what you enjoy doing.  He’s trying to get to know you as a person. Answer as honestly as you can. Check-in with yourself and see if you feel he’s engaged in your answers

• He’ll ask you about medications and medical issues you may have so he has a complete picture of you, physically, emotionally, and psychosocially.
• He’ll then discuss your symptoms and how he feels he can help
• He'll then give you his clinical insights. Listen closely to his thoughts. Active listening paves the way to healing.  Ask him questions if you don’t understand what he is explaining.

• Sometimes our psychiatrists give us feedback we aren’t happy with. Don’t disregard his clinical judgement because it makes you uncomfortable. Tell him his insights are uncomfortable for you. He’ll address your concerns without judgement.

·         Ending the appointment

•       Ask where he has hospital admitting privileges
•       Ask how to contact him if you have an emergency
•       He’ll tell you when he wants to see you next
•       He may give you a prescription
•       He may give you orders for medical tests
•       He may want another appointment to get more information from you before he decides on a treatment.

·         Deciding whether to return is a hard choice. Things to keep in mind:

•      Building a trusting relationship takes time
•      Unless the MD was a complete disaster, give the relationship time
•      Follow his instructions and make the next appointment with his office manager.
•      Spend some quiet time going over everything the physician said and what you think about his clinical advice. Be open minded.

In the next post, I’ll discuss expectations. The single biggest killer of a psychiatrist-patient relationship or psychotherapist-client relationship is having unrealistic expectations.

Over to You!

Learn more about my groundbreaking book on how I ultimately found healing and joy from cementing a 20 year collaboration with my psychiatrist Dr. Y. Read more about this book and how it can help you here. 

Follow me over on my Facebook Fan page where I often have light hearted conversations about what people often think of as dark topics.  Think of them as your daily dose of inspiration. We don't want to drag you guys down!

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Finding Your Psychotherapist Match: The Strategy

Finding the right psychotherapist for you isn’t as easy as picking a name off an insurance provider list and showing up in their office. If you want the best chance at good chemistry, you need to have a plan to find Psychotherapist Right.

So... How do you pick a psychologist or psychotherapist?

1.Assess your needs. Do you need someone to help you sort out complex issues or pesky life’s problems?  Ask yourself “what do I most need right now?” Make a list in order of your priorities.

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      2.Check with your insurance provider. Find out what categories of professionals are covered under your plan.

•      For example, my plan only covers psychiatrists and psychologists. Because of my complex illnesses, that’s a good fit for me.

      3.This is the research project part.

• Find 3-4 names of providers. Maybe your family doctor, clergy, friends or family have suggestions.
• Be careful that you don’t pick a provider that your friends or family are currently seeing. That is a conflict of interest for the provider.
• Creating your own list of providers is a place to start.

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4.If you aren’t self-pay, check to see if any of the providers from your list are covered under your insurance.

• Cross off the ones that aren’t.
• In a pinch, pick a few names off of your insurance policy provider list. This is the equivalent of cold calling for a therapist. Not the most effective approach but sometimes it’s your only option.

5.Call each psychotherapist/psychologist on that list you created.

• Leave a message saying who you are, how to reach you, when to reach you, and a brief description of why you are calling.
• Consider writing down the message you want to leave before you call. That way, you’ll know what you said to each provider and you’ll also get your key points into the message.

6     6. When they call you back, treat the call as a phone interview. You are interviewing them. Take notes

• Ask about their training, expertise (including the therapeutic technique they use), and experience
• Pay attention to how thoughtfully they answer your questions
• Give them a brief description of your major issue
• Pay attention to their answer. Did they listen? Do they come across as knowledgeable and empathetic?
• Keep a notebook of their answers and your impressions

7     7.If you find one or two you’d like to meet in person, make appointments.

       8. This is the face to face interview. You are trying to make a match for yourself. The little things matter.

• Gender may be important to you.
• Their demeanor may be important to you.
• Age may matter to you.
• The office style may matter to you.
• The convenience of parking or bus access might be a deal breaker.
• Do their appointments run on time?
• You won’t know the answers till you go and scope them out.

9.As you enter into your hour-long session, check-in with yourself. How does this interaction feel to you?

• Are you at ease or vaguely uncomfortable? Does your provider notice if you are uncomfortable? How do they help you resolve your discomfort?
• Are you getting good feedback that you find helpful
• How is their listening style. Do you feel heard?
• Is there anything in the session that is off-putting to you?

10.After you have compared and contrasted your face to face interviews, either make a selection for a second appointment or start gathering more names. The fit between you and your psychologist or psychotherapist is important. You’ll be sharing deep parts of yourself with them probably every week. That’s a lot of contact. Keep in mind that you have many options to choose from with psychotherapists. It’s okay to be a bit picky.

Read this post for the strategy for finding your psychiatrist-patient match. Psychiatrists are trickier to scope out. 

First of all, they are MDs. How many people get in depth research information about their dermatologist? Second, psychiatrists are a pretty rare breed. There just aren’t that many to choose from. You have much more limited options than with psychotherapists.

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About My Book: Finding My Voice: A 20 Year Psychiatrist-Patient Odyssey

“Somebody, please, tell me why am I dragging myself into my psychiatrist’s office every month and swallowing all these pills when it’s not helping!!” Tragically, when this plea finds no insight, treatment is either abandoned or the patients doctor hop. Patients scour physician directories hoping to discover that one unicorn MD with the magic elixir.

The abandoned truth is that even though imperfect, psychiatry, with physician and patient persistence, can be effective. Sticking it out can mean a breakthrough. The physician doesn’t even have to be a unicorn to make a difference in a patient’s life. For people like myself, treatment can be restorative and it is often our last best hope to conquer complex and lethal illnesses. This may be unpopular to say, but psychiatry just does not get enough credit for all the human triumphs, big and small, it cultivates.

It’s easy to harshly criticize the field’s painstakingly slow methods and very public failures. However, in hospitals, medical arts buildings, and private offices, quiet victories occur with stunning regularity. The delicate work of Drs. and patients too often go unnoticed and uncelebrated.

It is appalling that there are so few published personal accounts of these psychiatrist-patient expeditions. If a struggling human being thinks that they travel alone, where does the inspiration to swallow one more pill or share one more symptom come from? This book is remarkable, not just because it shines a light on the hope embedded in psychiatric treatment, but also because the odyssey it details is unique.

My story chronicles the birth, nurturance, and maturation of my two decade long therapeutic bond with my psychiatrist. This journey begins at the precipice of madness and continues through to the resurrection and redemption of a brutalized psyche. Our psychiatrist-patient relationship isn’t perfect but it is enduring and transformative. 

We’ve hung in there with each other against some pretty overwhelming odds. Along the way, we’ve learned a few things about converting treatment failure into triumph.

It has been by facing our faults and celebrating my many conquests that we continue to sojourn together. To the person struggling to stay in treatment, my odyssey is meant to be a glimpse into the possible. My profound regret is that more of these healing journeys are not shared.