Is my psychologist right?...

[MJG017]

So I have a question that has been bothering me since my last appointment with a psychologist a few days ago.  Basically I have been seeing them through the oncology psychology service offered at my local hospital, to you know... deal with the stress, anxiety and general drama that dealing with cancer brings.  So I don't generally talk to them about all my other issues.  I had used my 10 MHCP visits this year for that.

Anyway, the past 3 visits I got the very strong feeling they wanted me to stop using the service.  At the start of every session they give you one of those mental health screening assessments to see how you've been feeling recently.  Mine have generally been pretty bad since a not-so-good test result last December.  Before my last visit they hinted quite strongly that my results weren't improving and were still very high scores so maybe this wasn't working for me.  I said I felt it was because I found talking to them about it helpful and that yes I'm still having trouble dealing with the new realities of everything but I wanted to continue working on it because it was still causing bouts of deep depression that I couldn't control.  That seemed to work the first time.  Then the next session I was also told, when the subject came up again, that maybe I've had too many sessions.  Finally in my last session a few days ago it was brought up again but this time a bit more... 'less-hinty'!

I told her that I had booked an appointment with the people I had spoken to 3 years ago when I got my adoption records as I had recontacted them and asked if their service could help me work through my attachment issues (which I had just discovered the concept of and thought it explained a lot and described me pretty accurately) and I was told that I should just see them then instead of continuing as I was.  I said that I was going to this new service to work on my ongoing childhood issues and that I felt the cancer issues were separate.  So I would like to work on them both independently, although admitting there is some crossover, but that ultimately this was a service through Relationships SA and so not suitable for helping me to deal with depression from serious health issues.

So she then told me that it makes her feel bad when I keep coming in to speak to her and she feels like she isn't helping me.  Maybe it was because I didn't immediately drop to my knees and beg her forgiveness for making her feel bad but she then went on to say I was using this service as a crutch and that I would be better off being discharged, because I would then work on my issues relating to my cancer, rather than not dealing with it because I had the 'safety net' of coming to these appointments.  I really had no answer to that and just felt like I didn't want to continue if every appointment was going to have more and more time devoted to me basically begging to continue.  The service is free for cancer patients and so it's not easily replaced without paying to see someone else which isn't easy when you're not working.  So i said I believed her that this might end up being beneficial for me to leave and left.

So now I have no professional support in regards to dealing with my diagnosis.  I still have my support group which is great but not really helping me to accept my own battle and worries about the future.  It's been really bothering me since that appointment finished and so I just wanted to get some other opinions.  Was she right and it will be helpful for me to not see them anymore?  Or were my ongoing string of bad test results bringing their averages down so they wanted to move me on?  I sort of feel a bit abandoned and like I was just thrown in the too hard basket.  Maybe is was just good advice and I need to try it... I really don't know.

Thanks for any thoughts you may have to share.  Sorry about the long post but, well it's me, so that's just going to happen! 🙂

[tyme]

Hey @MJG017 ,

I'm hearing this from both sides. I hear you are wanting support, and from the psychologist's point of view, they don't think they should continue with you - is that fair to say?

I hear how hard this can be for you.

Do you think it is about the money, seeing you don't have any MHCP sessions left?

Do you think she feels she can't work with your level of need?

Do you think she may feel threatened by her limited capacity?

I really don't know, but these are things to think about.

In the past, I've worked with a lot of clients in private practice. There comes a point where I might need to tell the client that it may be good of them to have a break unless something changes. The reason for this was that I didn't feel there was movement in the work. I felt we weren't getting anywhere, and the things they learnt from me, I'd like them to give it a go themselves.

Do you think this is similar?

Please know you are not alone.

Alternatively, are you able to ask her to recommend you someone else who may be willing to work with your level of need at this time?

[MJG017]

Thanks @tyme.

I do see it from their point of view but the thing is i'm still new to this and everyone told me that these things take time to get through and start to resolve, or at least improve the issues.  Now apparently i've had too long.  I've told them i'm at a point where I cant control the depression about the diagnosis anymore and can't stop the pessimistic thoughts because the inevitability of my situation weighs very hard on my mind and the only question is time rather than 'if'.  Plus, it was only at the end of last December that things really took a downward turn based of that result.  I just wanted some help dealing with it all and all I got for the 5 or 6 session this year was to not overthink, stay positive, and not assume the worst.  Even though, like I said, the worst is more of a matter of 'when' than 'if' at this time.

I really don't know what the reasons are.  The psychologist I saw on the MHCP visit, never did those assessments each visit, so there was this pressure at the start of each appointment to explain why my score is still high.  It felt more like a maths test where I keep failing.

So maybe I do just need to give it a go alone, but I really worry about the next test in 3 months.  The week or so leading up to the last result last week was extremely difficult and I just don't know If I can keep doing it every three months.  I told her the only though that got me through recently was the if it's a bad result then at least this stress and anxiety would be gone and I'd only have the depression to work on. 

I sort of expected this from the last 2 appointments,  so I had planned to ask about other support services available, but after things ramped more than I expected I just told her what she wanted to hear and left.

Thanks for your thoughts Tyme, I really appreciate them, especially with the experience you have.  It gives me some things to think about.  Maybe she was just being completely honest with me and doing what she thought was best, like the clients you talked about.  Maybe i'm just being too cynical.  Like I said, things to thing about.  Thanks again, and I hope your weekend is going well.

[Emelia8]

Hi @MJG017 😊

I am sorry to hear that you have lost one of your psychological support people.  Yes I know of the counselling services offered by most oncology sections of hospitals.  I have been through those, firstly with my late husband, and then more recently for myself.  I found they offered a helpful, though fairly basic, service.  And admittedly I never ventured off the topic of cancer related issues for myself.  I have PTSD, but did not bring that up with them.  I didn't see it as relevant to their cause.  I see them as offering a very specific service which relates specifically to a diagnosis of cancer and how that affects us and our lives.  Yes its very true that a diagnosis of cancer definitely increases our levels of anxiety and depression.  Which of course you also get with PTSD.  But I did not ever go into that with my counsellor.  I always had my clinical psychologist, and yes my 10x sessions of MHCP, to discuss and treat my more vulnerable and traumatic PTSD symptoms.

So for me, I always kept my cancer issues very separate from my other MH issues.  Rightly or wrongly.  But I guess, speaking about my trauma is not anything I can talk about to just anyone.  It took years for my clinical psych to get the story out of me.  So I'm hardly going to blab to a counsellor.

I do think its most unfortunate and unfair that you have lost this support.  As a cancer sufferer, and survivor, you are entitled to it.  Its most disappointing to hear that the psych made it all about her, ie that you made her feel bad that she couldn't help you.  As for you using the service 'as a crutch' ... well isn't that the idea? Cancer sufferers need a crutch during difficult times, and they are meant to provide just that. I must admit I find the whole interaction from her most confusing. 

I do hope you are okay, and can find an alternative source of support.  Do they have an alternative counsellor/psychologist by any chance?  I expect not, but worth checking.  Meantime, I hope you continue to utilise the support group.  Good luck.

Emelia 

[MJG017]

Hi @Emelia8, thanks for your reply.  I'm sorry you and your late husband have had to battle this disease, it's not easy on anyone and does certainly add a lot of stress onto everything else we're struggling with at the time.

I've also kept my non-cancer related issues separate when talking to the psychologists, especially the oncology one.  I only talked about other stuff if it was relevant to dealing with the cancer.  For example, the near total lack of support from family and friends since diagnosis, stemming from not really having those strong connections throughout my life.  I didn't say it to work on that in any way, just to explain how difficult it has been without that extra support around me, and how frustrating it is that the family I do have seem to show no interest it how i'm going with the treatments, let alone going mentally.  I too, used my 10x MHCP visits to talk about more general issues in my life, the cancer being one, so it was more of a mix with her, but I still did prefer to talk more about other issues there because I didn't deal with them with the oncology service.

For me, the oncology service was the first psychologist, or any type of counselor, I had ever spoken to in my left.  Except for the adoption support person 3 years ago for 1 session now that I think about it.  But I was unsure about it when I started and felt guilty for using the free service so I did ask during my first session, is there a limit to how man session I could have and they were quite clear I could have as any as I needed while still going through treatment or recovery, so this change did seem like a sudden change in policy to me.

With not being very experienced with these sorts of services, it left me confused and a bit angry, as well as just concerned for what I was going to do next.  Being told it is only "a short term service" was different to what I was initially told and confusing as you would know better than most... dealing with cancer isn't actually a short term thing.  Especially when you're in a position that a cure is out of the question and you're 100% relying on treatments to hold it back for as long as possible, and you've already become resistant to the main one.  So I guess I found it a bit dismissive of my situation and a bit lacking in understanding as well.

But as @tyme, suggested, maybe they don't feel capable of helping me and are just trying to get me to seek help somewhere more capable.  If that's true, I'd rather they just told me that. 

Fortunately I do have the support group, which is important to me as I helped to create it.  It's a group specifically aim at younger men (40s, 50s) with prostate cancer so I find it very helpful but it's not the same as just being able to sit down with one person and talk about myself for an hour.

I have reached out and have gotten a recommendation for a local psychologist who was helping her husband death with his prostate cancer until he passed away about 6 years ago, so maybe he can help but I feel like i've lost a lot of trust in the profession.

I hope you're are doing okay with your own fight and i'm sorry to hear about your husband.  Good luck to you as well and thank you for your thoughts and support.

[Dimity]

Winding up sessions because you're not improving sounds a bit like victim blaming to me @MJG017 and doesn't seem like the supportive care  you'd need.

In my case public sector counselling was withdrawn because I'd received the average duration of therapy that my psychologist's management said should be aspired to. That, and I had medical issues that were apparently a distraction and therefore not to be talked about even if they exacerbated my difficulties.

With all the assessment tools your psychologist kept wheeling out it does sound as though they were contending with their own performance appraisals as much as or more than your wellbeing.

I'd wonder if you could transfer to someone else in the oncology support team... or if there's a cancer support organisation in your state who could give you ongoing compassionate care.

[MJG017]

Thanks @Dimity.  "Average duration"?!  How is that even a thing?!  Like fixing mental health is like changing a tyre... it should only take a set amount of time or you're doing it wrong!

I just don't know.  I know I need some time to rethink things.  Every instinct tells me to just go it alone, but that's because that's they way I dealt with things my whole life and that voice is my head is saying "See, I told you so".  I think I may need to talk to some of my medical team and talk to them and see what they recommend or is available.  I'm just not up to that just yet, but I do think that is the best next step.

The support group is great, but I don't know if it's a guy thing... but it feels like there is a lot of pressure to say you're coping okay.  We talk about the mental struggles but rarely the details of just how bad it can get.  It seems like it's okay to admit it's hard but then follow it up by saying "I'll be fine though" and then make a joke.  The fact that the very few family and friends that have asked how I was doing during this got a pretty honest answer from me rather than the "I'm doing really well" only to have them then stop asking probably makes me a bit over sensitive to talking about it to anyone except the psychologist.  Which is the main reason I felt it was still a huge help to me no matter what some score out of 20 says.  I'm in a worse position with treatments than I was a year ago, so is it wildly surprising that mentally I might be doing a bit worse than a year ago as well?

Some days I just have trouble picking which mental fight I'm going to take on that day, because all of them at once is just too much!  So i just really want to thank everyone for their support... it really has helped immensely because I know it would have been another downwards spiral without it. ❤️❤️❤️

[Dimity]

I concur with just about everything you've written @MJG017 . Withdrawing and self reliance are probably learnt responses. And spoon theory says we won't always gave enough spoons for everything on our plate.

Instruments like the K10 and DASS21 are doubtless useful for screening but can't reach the depth and complexity of what's happening for us.

Is there a Cancer Council in your state? They may be able to help with support services.

It's rough when we can't even say we're not OK without feeling we have to ameliorate it. And worse when we need acknowledgement but know asking for it sets us up for further rejection, whether it be friends & family or medical and mental health professionals. 

Take care. I hear you're not OK, and that's something we can sit with. Are some days better than others?

[MJG017]

Thanks @Dimity, it's reassuring to know i;m not the only one who sees many flaws in this system. When I told my partner what I was told last week, she took it worse than I did.  I had to tell her not to make a complaint.  I'd rather just move on to something supportive and focus on that right now.

Withdrawing and self reliance have always been my go-to defenses.  But for the first time in my life, they just dont work anymore.  I can't go into my hole and wait this problem out.  So I just don't know how to deal with it.  I really though a psychologist could give me some tools to help me cope.

We have the Cancer Council SA here.  I've done some work with them as a 'consumer representative' assisting them with some research.  I can reach out and ask the what is available with support services, they may have some or have some ideas.

I'm doing okay at the moment.  I think it's just the smallest, most insignificant things can put me into a depressive hole and it happens more often as time goes on, and can get harder to get out of each time.  I worry about late November leading up to my next test result.  That is going to be very difficult again and I hope I can get some professional support before then. 

The more annoying thing for me was that we scheduled my last psych appointment a few days before my last oncology results appointment because I said I would be really struggling that week leading up to it, so having the appointment then would be best for me.  They cancelled that appointment a couple of days before and rescheduled the week following my test results, so I had to deal with the lead up to getting the results without any professional support anyway and it was extremely difficult.  Enough that I'm really worried about how many times I can go through that (with them coming every 3 months) without getting some help finding some sort of acceptance of the situation.  I just don't think I can keep going through that so often for very long.  But i'm finding ways to keep it under control for the moment. 

Thanks again.  It all really helps.

[Dimity]

I hear you re needing timely support around the tests @MJG017 . I recently had scary eye surgery and think I only got an extra psychology session because I contacted the local psych triage number, who act as gatekeepers to services. I got the session, and the psychologist immediately discharged me.

If you're after tools and techniques for coping  perhaps linking with a community of survivors might help more than your psychologist.