How to Maximize Your Time with A Therapist

Every December, I return to my family home in the USA from Costa Rica. This voyage signifies the beginning of the holidays for me, and also indicates that it’s time to see my therapist, whom I only visit once a year. During previous visits, I’ve made sure to schedule a double appointment to allow us plenty of time to review the year, current symptoms, and medications. Based on these experiences, I’d like to offer a short list of ways to maximize your time with a therapist that you may see infrequently or annually, like me.

  • Keep a Journal of Your Year – I’ve been writing a short journal of each year since 2006, highlighting events that caused me stress, produced BPD reactions, or altered my behavior patterns. To be clear, the journal is not a day-by-day discussion of my life. Instead, I keep it just under 10 typed pages, covering about 12 different topics that I really want to review with my psychiatrist. I write it early in December before I travel, so that I can put together a document that has a central theme, is cohesive, and thorough. Then, I mail it in advance of my appointment, so my doctor can read it and comment. I realize this might seem like a big production, especially if you can keep an appointment agenda in your head and then discuss it extemporaneously. For me, however, I prefer to write, so that I can communicate effectively and succinctly.
  • Keep Your Therapist Focused – Don’t forget that psychiatrists/psychologists are people, too. They have their good days and bad days, even if they have years of experience and countless satisfied patients. During my once-yearly double appointment with my doctor, I make sure to keep the conversation on topic and flowing. Inevitably, we might stray off on a tangent for a few minutes, but eventually one of us steers the discussion back on course. Some therapists are more chatty than others. If you have a very talkative therapist, politely remind them that you have a short amount of time to review a lot of important information. If they’re worth their salt, they will understand your concern. Don’t forget, you’re paying THEM for help, not the other way around.
  • Make of List of Prescriptions to Renew BEFORE the Appointment – This might sound anal retentive, but I find writing down notes regarding my medications before the actual appointment to be great reminders. Many times, I get caught up in the discussion with my therapist, and will forget to mention that I need to renew my Effexor or Welbutrin. When this happens, it only causes stress later on when I have to either call my therapist and arrange to pickup the prescription, or coordinate a plan with my local pharmacy. Keep things simple: write down a list of eveything you take and put it in your back pocket. When you’re leaving your appointment, be sure to take it out and make sure all your medical needs are met and that your prescriptions are current.
  • Ask If you Can Communicate Using Other Methods Besides In Person Appointments – If you only visit your home country once a year like I do, sometimes it’s good to know that you can reach your therapist through alternative means. Most therapists are happy to schedule phone conversations, if they are planned well in advance. If you decide to go this route, make sure you are the one calling the therapist and picking up the charges. This is a nice gesture and will avoid costing your therapist exorbitant amounts of money for a long distance call. If you’re short on cash, setup a Skype account, which allows you to call anywhere in the world for minimal fees. Note also that you will be subject to your doctor’s normal billing practices, which means you might get a copay notice from your insurance company.

    Some other therapists might offer email communication, which can be an effective way to patch up any small emergencies in your life without putting an undue time burden on the doctor or yourself. Speaking personally, my doctor does not do email because of limitations imposed by her malpractice insurance. If you’re in the same boat, try to setup a call which is the next best thing to visiting in person and is permissible under nearly every insurance policy. Again, if you exchange a series of emails with your psychiatrist, it’s likely he or she will charge you for their time. Make sure you pay them and your health insurance provider in a timely manner.

I hope this list is helpful for those that don’t see their doctors that much, but still have to deal with their BPD every day. Organization is the key to success. Write down notes about symptoms you are experiencing before visiting your doctor. Also, don’t forget to write down any prescriptions that need to be renewed. Most importantly, whether you see your therapist in person, chat on the phone, or exchange emails, make sure that you use the time efficiently. Don’t waste time with off-topic discussions that don’t address helping YOU feel better.

I Recently Adopted a Kitten – Hopefully BPD Won’t Get In the Way

Just over 2 weeks ago, tropical storm Tomas was ravaging the Caribbean, making landfall on Haiti and dumping rain all over Central America. In Costa Rica, where I live, the rain was so bad that a national state of emergency was declared. Thousands were displaced from their rain damaged homes, and over 20 people perished in landslides resulting from the deluge. Others were affected by the loss of running water, because the old pipe systems used by the National water company were not able to handle the excessive amount of run-off. It was incredible to say the least.

On Friday evening during the week of the storm, I was watching TV as usual, a Keith Morrison Dateline NBC mystery (yeah I know, there wasn’t much else on 🙂 ). Inexplicably, I started hearing a whining sound, almost like an animal was screaming. My first thought was that an opossum or other small animal got hit by a car. Usually when this happens, the wounded animal will find a hiding place and recuperate on their own, since the warm climate here in Costa Rica doesn’t necessitate the need for constant shelter. I thought the animal would eventually make its way out of my neighborhood, but it didn’t.

Finally, after about 35 minutes of Keith Morrison and continued animal cries, I went outside to investigate. As I honed in on the noise, I began to think that it was the distressed cry of a cat. There are a few cats that frequent the area and perhaps one was hurt. As I drew closer, however, I realized I was only partially correct: the screaming animal was actually a lone kitten, with no mother, no shelter, and no food in the middle of a damp, rainy night.

Needless to say, I was touched, and proceeded to spend the next 3 or 4 hours trying to lure the kitten towards me with various noises and calls. Nothing seemed to work. So, before I went to bed, I left a can of tuna fish open near my doorstep, hoping the kitten would smell it and finally have a meal.

The next day, I looked at the tuna fish can and noticed nothing was consumed, yet I could still hear the sound of the kitten running through the brush crying for help. Eventually, it found its way into my garage, where it began sleeping within a trash bag. Still, the kitten would not come to me when I called it, but at least it was out of the elements. I relocated the tuna fish to the garage, and after subsequent visits, saw that the kitten was eating the food. I was really relieved: the last thing I wanted was a dead cat on my hands, especially if it belonged to someone in the neighborhood.

In the ensuing days, I thought someone might come calling for it, so I really didn’t do much more than continue feeding it tuna fish and milk. I put myself in the shoes of the cat’s owners, thinking that it would be better to keep in one place so that it could be found. Unfortunately, however, no one ever came for it. I looked for lost animal posters at a nearby supermarket and veterinary clinic and saw none that matched the kitten’s description. Now, I had to make an important decision. Should I ignore the kitten and let it forage for food on its own, or should I take it in and give it a home?

Needless to say, my emotions pulled me to the latter of the two scenarios. Luckily, my apartment landlords didn’t have a problem with a cat living in the building. They suggested that the cat appeared because someone may have dropped it off during the storm, unable or not wanting to care for it. I really felt bad for the kitten and decided to make it my own. After a couple days, I was able to coax it into my lap and start building trust.

About 6 days after I heard it screaming that Friday night, I was able to pick up the kitten and bring it to my apartment. I made sure to be ready for all possibilities: I picked up cat meat, kitten kibble, toys, a litter box, and plenty of litter. I also shut doors to rooms that were normally open, in order to keep the kitten from soiling too much of the apartment. I designated one of my old towels as a de-facto bed, placing it on an old couch so that the kitten could rest.

The following week, after cleaning up cat pee and poop (while teaching the kitten how to use the litter box) I brought her (well, I thought it was a girl) to the vet. The doctor confirmed the sex, gave her an initial round of shots, and a basic exam. Aside from a parasite in her intestinal tract, she was healthy.

So now, I am officially a cat owner. It’s nothing new: my family had cats and dogs when I was a kid so I’m used to the routine. With this kitten, however, things were a little more frustrating because it had a lot of accidents and was a bit stubborn. She also followed me around the apartment constantly, and at times I felt a bit smothered. Still, I convinced myself that taking this animal in would be much better than dropping it off at a shelter, where God knows what happens to unwanted animals in Central America.

To tie this blog together, I really only have one fear with raising this cat, and that’s my BPD. BPD can make me temperamental and inconsistent, two things that confuse animals when you’re trying to discipline and rear them. Also, I fear the “all or nothing” BPD button in my head might switch “nothing”, such that I begin to deplore the cat’s presence and want to get rid of it. That simply wouldn’t be nice, but it’s really no different than having a relationship with another human break down because your BPD suddenly turns you against them.

For now, I think the safest thing to do is just take it day by day, even if the rest of my life is hectic. The cat has given some routine to my day and cheered me up. It’s also very comforting to have a little companionship and someone to watch Dateline NBC with 🙂 . Her litter box habits are improving, and slowly I’m allowing her more privileges in the apartment.

Sometimes its better to let your emotions do the talking, even with BPD. In this case, I was able to rescue an animal and give it a home. I really felt good about what I did, and I continue to feel good about it to this day. No matter what happens, I know I have allowed this cat a second chance at having a normal life, even if it means living in a small apartment with a sometimes nutty owner. 🙂 “Esperanza”, is now a fairly happy feline. Take care of your pets!