Me Again, with a Report on My Intensive Outpatient Program

Like me, this guy may be subject to irrational frenzies, but he's still furry and wistful.

As I’ve noted, I’m now involved in an intensive outpatient program at a nearby hospital. It’s a huge commitment — nine hours a week — and it’s necessarily eating into my blogging time. I’ve given myself permission to write a good deal less, partly because of the IOP, and partly because I hate the trappings of the 21st Century (as you know).

As I was buzzing around the house cleaning obsessively (a new hypomanic symptom for me — I’ve spent much of my adult life living in squalor), I figured out a couple of things concerning my loathing of the mental health system.

As I’ve mentioned, two-thirds of our therapy sessions in the IOP are run by a gentleman whom I will call A, who is the best therapist I’ve ever worked with. I mean, this guy beats the godlike Dr. B who treated me when I was in graduate school (though Dr. B was dashing and handsome, and the IOP therapist is not especially attractive). Oddly, the remaining third of the program is run by a woman, V, whom I would cheerfully strangle. She easily ranks among my worst therapists, and I’ve endured sessions with counselors who were so incompetent that they presented a public health menace. I spend much of her hour disassociating, which I haven’t done since the last time I was hospitalized.

Why does she rile me so? For that matter, why does my soon-to-be-former shrink drive me nuts? I often puzzle over this as I drive home from evening sessions. I figured part of it out two nights ago, and more while organizing my junk drawer this morning.

First, V is a crappy listener. She spends her sessions with us pronouncing all-too-familiar 12-step and therapeutic truisms. “Take it one day at a time” is undeniably excellent advice, but we need concrete coping strategies, not general rules. A, on the other hand, asks questions, expresses empathy, and helps us to explore how to cope with our lives and illnesses. The contrast is striking.

What’s more, whenever I do speak V flatly contradicts me, essentially saying that my experience is uniformly wrong or mistaken. This enrages me so much that I snap my mouth shut for fear of snarling ugly imprecations. For example, V thinks my shrink walks on water, and I’ve reached the conclusion that said shrink is a quack. It’s not surprising that V should favor this doctor — they both recite irritating cliches instead of engaging with patients. The real horror is this: the arguments between me and V reproduce the tiresome and seemingly inescapable dialog in my head. No wonder I’m angry precisely one third of the time at my IOP — it’s like seeing my most misery-inducing interior monologues come to life.

Of course, some of you are probably thinking that I should be more grateful for the help I’m getting. I’m sure this is true. It burns my ass, though, when people who are not in a position to know suggest that I’m too cynical and negative about the health care system. I hate being told that I should be grateful for crappy care. I approach each new drug, shrink, and therapist with buoyant hope, and my anger is largely a product of intense disappointment.

It’s interesting that A and V subscribe to the same theoretical model. Many clinical studies have reached the conclusion that the form of therapy matters less than patients’ perception that their therapist genuinely cares whether or not their quality of life improves. I may be wrong in feeling that V is uncaring, but the mere semblance of arrogant indifference is profoundly disillusioning.

Enough. I actually am grateful for A’s help, and the handouts and techniques have proven valuable, not just in the group, but in everyday settings.

Love to all. I will likely write more this weekend.