Seeing a new therapist and given a “Stressors” exercise

I’m happy that I have a new psychiatrist and new mental health counselor to visit.

In the past, my psychiatrist administered both medication and therapy. This made sense to me because there are occasions when the need to change medication dosages becomes more apparent during discussions about one’s behavior and social interactions. I remember a few times when my psychiatrist would give me the usual battery of questions regarding medication side effects, which got “yes” or “no” answers. I almost always passed these cursory examinations. Later on during therapy, however, it became clear that medication was affecting my behavior and stress levels, and therefore needed adjustment. Seeing one person was more efficient.

Now I’m on a different system: the psychiatrist monitors global trends in my mental health and keeps prescriptions filled, while the mental health counselor helps me with day-to-day struggles. Each professional is in the same practice, which means communication between them will hopefully be fluid and constant. Maybe two heads are better than one. I’m willing to give it a chance. If I feel like each provider doesn’t speak to the other, I’ll be leaving rather quickly. 20 minutes for a med appointment doesn’t cut it unless I’m actually happy and productive in my life. At the moment I’m not quite at that level of satisfaction (yet).

My mental health counselor seems intelligent and professional. At first I was concerned that he didn’t have a terminal degree. I thought most therapists have Ph.Ds or something equivalent to adequately manage patients. My therapist has some other form of qualification that seems sufficient. Ultimately I think it comes down to how good they are with YOU opposed to the alphabet soup after their last name. Some doctorates are arrogant and dismissive, while someone eager to help others with a master’s degree might be much more beneficial. Pedigree might not always matter except for extremely difficult cases when you want someone with rock solid credentials and years of experience on the job.

In fact, one of the first psychiatrists I visited in my new city had good credentials on paper, but seemed a bit scattered and tired. He had spent years working at an in-patient facility and such work undoubtedly wears down even the most headstrong doctors. I got the impression he was headed towards retirement and seeing a few patients part time in his own private practice. There’s nothing wrong with that at all, but I didn’t think his energy level was a match for my high-strung perfectionist personality. He also suggested I add Xanax to my medication regimen in addition to the Klonopin I was already taking. When I mentioned this idea to other doctors (not using his name for privacy) they all disapproved.

Xanax is Klonopin Jr., with a shorter half life in the bloodstream. I didn’t think adding another benzodiazepine would be in my best interests long term. Ideally I’d like to be med free. The Xanax prescription he gave me was torn up and tossed in the garbage.

Last week I had my initial appointment with the mental health counselor, which was the usual game of 20 questions. His style was structured and minimalist. Sometimes I don’t know how to answer big questions without more specific parameters, but for the time being he just seemed interested in hearing whatever came to mind.

He also gave me a homework assignment. Initially I thought it was a little trivial, but after beginning the exercise, I actually think it has been helpful. It’s very straightforward:

1. Day one: Write down all your stressors on a sheet of paper, then pick your top 3. Write each stressor on its own blank sheet of paper. Everything must be completed by hand with no computer, TV, cell phones, or other distractions present.
2. Day two: Write down how stressor #1 affects you in detail using one sheet of paper.
3. Day three: Write down how stressor #2 affects you.
4. Day four: Write down how stressor #3 affects you.
5. Day five: Take the day off.
6. Day six: Reflect on your writing, making corrections, edits, changes, etc. as needed.
7. Return to next appointment with the assignment complete.

Today is my day off, so I’m not 100% finished, but I’ve noticed a couple things:

1. The amount of stress something gives me varies day to day, even though I feel like the weight of the world is upon me. In other words, the stress I feel is relative to my emotional well being, and I might feel less stressed if my emotional needs were being met.

2. I had trouble picking my top 3, so I wrote down an “honorable mention” section on my first sheet of paper to include a few other stressors that make me crazy. I realize this wasn’t part of the instructions, but part of my personality has a hard time committing “anything to stone” (so to speak) because I’m always vacillating up and down the emotional spectrum.

3. My hand writing is horrible. I’ll have to make copies to aid the therapist when we read through the sheets this week 🙂 .

I’ll be interested to see how he processes my responses and what conclusions he draws, if any. My guess is that he won’t make any judgments per se, but instead ask me to explain all the emotional factors creating stress in my life and how they can be decreased. Then, based on my own course of action, he’ll provide tools/coping mechanisms to reach my own goal.

…but that’s just my guess. We’ll see what happens this week!