The VA has approved me for community care! Instead of a revolving door of unprofessional incompetent clowns who specialize in PTSD, I can select one of the incompetent unprofessional clowns from my community who specialize in BPD!
How should I look for a psychologist? There’s like, a lot to choose from here. Most everyone mentions “specialties” like bipolar on their site, in among a bunch of stuff like ptsd and depression and lgbtq issues- Which makes me think they aren’t actually specialists, which gives me the impression they’ll say just about anything to get me in the door. It’s all a bit overwhelming and I basically only have one shot. Once I engage with someone, if they aren’t a good fit (my history suggests it will take several sessions before I know if they’ll be a good fit, so…) I have to go through the several months approval process for community care again before I can make another selection, assuming I’m approved. How do you weed out assholes, idiots, and the incompetent before you see them?
What treatments have you found to be effective in your therapy?
Also, I’m much better on Lithium than I ever have been, but I’m already coming close to the maximum safe dose- if there is such a thing. The psychiatrist mentioned depakote, but I’ve tried that before and had severe gastrointestinal problems. Are there any other medications I should be looking out for or asking about here?
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Caveat I’m not a doctor, but I am a psychotherapist with inpatient psych experience. In my experience, bipolar disorder is treated primarily with mood stabilizer medications, including lithium, depakote, or lamictal, with psychotherapy as an optional adjunct treatment mostly for people who are having difficulty coping with the social, emotional, or physical impacts of bipolar symptoms or medication side effects.
Lithium seems, on average, to be the best tolerated of the 3 meds I mentioned. Why do you think you need a higher dose if you feel like you’re doing well? The goal (under supervision of a physician) should absolutely be to be on the lowest dose possible to maintain stability.
Also, I’d be remiss if I didn’t mention that bipolar is what may be called a diagnosis du jour, in that it’s a label being given to many people who don’t actually have it, but instead have difficulty with emotional regulation related to other issues, such as trauma or borderline personality disorder, which are better served by psychotherapy. There are people who absolutely have depressive and/or manic episodes in the context of bipolar disorder for whom mood stabilizers are realistically the only option, though (besides ECT or TMS).
You mentioned PTSD…is that what you’d want to prioritize treatment for? If so, I genuinely would not bother seeking a therapist for bipolar, but focus on finding someone certified in an evidence-based trauma treatment. For this, cognitive processing therapy (CPT) is the gold standard, and EMDR is also an option.
Navigating this system is tough! Good luck, and sorry for the wall of text.
Why do you think you need a higher dose if you feel like you’re doing well?
I’m doing well in comparison to when I was destitute and homeless. No treatment for depression ever stuck. On Lithium vs off is like night and day. That said, I’m still struggling to cope with, as you said, social and emotional and, well, really very many things. I have an apartment now, but the only job I can seem to hold is uber. I struggle with very basic things that, goddamnit, I know how to do. What I need is the talking about my problems thing with a person who won’t try to blame all my problems on military trauma I didn’t actually experience. That’s what I mentioned PTSD for: VA docs don’t seem to be prepared to talk about anything else, and only in the context of the military. Most of my trauma seems to stem from a severely dysfunctional childhood. I need to talk about that shit, really badly, with a competent professional I trust, not just the guy who replaced the last lady I was seeing for a bit who replaced the last…
And why do I want a higher dose? I want to succeed in life. If stepping up my dose will do that without hurting me, I want to do that. If not, I want something else. I just want to get my goddamn life started. I’m 32. I have nothing at all to show for my age but despair and significantly more grey hairs than is appropriate for my age based on my family history.
Definitely sounds like you’re looking for psychotherapy rather than further med management. For psychotherapy, you’re going to be looking for someone with the credentials PhD, PsyD, LCSW, or LPC (these titles vary a bit by state). Finding a new therapist can be daunting…did the VA give you a set to choose from, or can you choose anyone?
If you’re in a place to be able to talk about the really hard stuff and not spiral into depression or out of control, you could find someone who specializes in a process-type non-traums therapy, like psychodynamic therapy, where you’ll explore how your experiences in childhood may be affecting your relational patterns and self-perception today.
CPT is geared more toward the type of trauma that’s a single, short-duration event, and may not be indicated for the complex trauma you’re describing.
If you would rather focus on “building a life worth living,” you might try dialectical behavior therapy (DBT), where you’ll focus on recognizing and interrupting unhelpful patterns of thinking, as well as skills related to emotional regulation, distress tolerance, and interpersonal communication.
There are lots of other options too. It can all be overwhelming, honestly
