Hey everyone :) I’d greatly appreciate some opinions on my current treatment situation. I recently started therapy with a new psychologist after two and a half years of weekly/fortnightly treatment (and a very traumatic therapist-initiated termination)

In my third session last week, my guard slipped and I could feel my vulnerable self emerging, which I’d been numbing a lot recently. Only this emergence happened without warning and in response, I had a dissociative episode. I knew where I was, but felt so paralysed with fear I didn’t feel I could be an active participant in my surroundings. I can hear what people say to me in this state but I can’t speak back or connect. It’s very distressing and I don’t feel my conscious mind has any control over the situation. It happens in intense waves and feels like falling down a vortex in your head.

My concern was my new psychologist’s reaction. She threw around the word “psychosis” and wants me to be assessed by a psychiatrist. This really concerns me. I really want to keep moving forward, and I feel like going to see a psychiatrist is nosediving me back ten years, putting myself into a position of being pathologized, trapped in a treatment pigeonhole as being much sicker than I feel I am being coerced into taking medication I don’t want. I can see the scenario playing out already.

- Psychologist wants me to see a psychiatrist.

- I don’t want to but go in order to accommodate her and out of fear she won’t feel able to treat me
otherwise.

- Psychiatrist listens patiently, then writes a script.

- I do my past meds spiel saying its not beneficial and I don’t feel comfortable with it.

- He tries to assure me this new medication doesn’t have side effects.

- I reluctantly go with it as he smiles, pats me on the head and gives me my script.

- I take the medication once or twice and experience at least one if not all of the following:

inability to concentrate/hold a conversation/write with a pen/feel any emotion whatsoever/use my brain in any way/physical symptoms

- I go off the medication and prove the point I was trying to communicate that psychiatrist involvement isn’t a good idea.

I can’t tell you guys how many times this has happened :( I want my new psychologist to feel comfortable treating me, but I really don’t want to go through this situation again.

What can I do? If you were in this position, what would you do?

Hi Teaandpugsleys,

I was really interested to hear your description of your dissociative episode. It was really well written and I thank you for so clearly describing to me and the community what its like to experience it. 

I have witnessed a patient having a dissociative episode in my room and I will tell you that from my side, it was pretty unsettling. I remember talking to my patient and then noticing she had a far away look in her eye. Then I asked her a question directly and she didn’t respond. She then started trembling and looked like she was both frightened and withdrawn at the same time. I didn’t know what I had done wrong. I couldn’t get any response from her and in fact she couldn’t physically move at all. She said later, she just felt “stuck”. I must say I was really happy that this patient had a psychiatrist involved that I could check in with as I wondered what the meaning was of this episode for her at this time and we were both a bit unsure. It was helpful to both of us to have a third member of our “team”.

I’m telling you this because I don’t know if you considered that the psychologist has witnessed something that for you is clearly a horrible, but yet also understandable and not absolutely unfamiliar episode.  However, she may have been quite unnerved with the episode and wants to be professional about it and ensure that she gets  the best team around you to work toward not slipping into dissociation when things get overwhelming . She may feel that ensuring that she has the right diagnosis, the right understanding of whats going on and ensuring that all pharmaceutical options have been explored is the professionally responsible thing to do. 

You say you want your new psychologist to feel comfortable treating you, then I think you have to work as a team with her to allow her to feel comfortable and that she is working responsibly and professionally. Most therapists would indeed refer  a patient with dissociation for a psychiatric assessment as dissociation is not a diagnosis, but a symptom . It can occur as a result of many things and being a new patient, I guess she just want to make sure that she is double checking that everything is in order ( e.g. , some people have been known to dissociate due to epilepsy ! So its always important for psychologists to get a medically trained person to check something like this out ) .

Just because you see a psychiatrist doesn’t mean you have to take a new medication. As an active member of the team you can be involved with the plan. It could be something like “Why don’t I try mindfulness, exercise, this new psychologist for 3-6 months and see how things go.. and then if that doesn’t work .. add a peer support group and if that doesn’t  work .. then i might come back to thinking about your new medication trial… “ Or whatever. What I’m saying is.. you don’t have to passive , you can be an assertive active member of the team ! 

So basically, my advice is - let this psychologist find her comfort with you and your symptoms, so if they happen again , she feels ok about it and so do you . Be strong  and yet open to new ideas. Don’t be pushed into doing things you honestly don’t want to but keep an open mind. 

Hi there Teaandpugsleys, I have no medical background, I'm just someone who experiences dissociation. I've been diagnosed with DID, dissociative identity disorder. A controversial diagnosis with psychs!!!

Do you have parts of your childhood that you can't remember?

Do you feel like someone, a child, young adult, wants to say something?

I feel literally beside myself if that makes any sense to you at all. Sometimes I'm watching on during a conversation.

I don't want to say too much in case I cause am of no help whatsoever. Wishful

Hi Teaandpugsleys.

My experience was a bit different to yours but I hope that relating it may help. I saw a psychologist for 2 years for depression and found that while the symptoms were treated, the underlying reasons were not. A friend insisted that I see a psychiatrist so I looked for one who specialised in therapy and childhood trauma, which I could see was what I needed. He did try to prescribe medication but listened when I said I didn't want to take it, and respected that I preferred to use exercise and meditation. He understood the dissociation, which freaked out my psychologist, he listened to my the dreams and took them seriously, whereas my psychologist just didn't get it, he understood the devaluing of my early relationships, where my psychologist though it was too long ago to make a difference. I know that this may be a generalisation, but the psychiatrist seemed to have the training needed to guide me though. We can't make people do what they are not capable of doing but if you look for a therapist with more experience in the area that is relevant to you, then perhaps it may help you all round.