Tag Archives: animal therapy

What is your fantasy, idealized treatment?

If you could design your own “treatment center”, with no regard to limits on finances or what seems “impossible”, what would find most helpful to you?

I am not sure how this topic came up this morning, but I ended up having a long discussion with my mom about what my ideal treatment would look like. It does not exist at this time, but it is based on my experiences both professionally and personally. A lot of it sounds impossible with today’s treatment models and financial limitations, but I think, at least for me, it would be hugely beneficial.

I have found I need a certain level of intensity to safely and effectively get through my issues, so I would want something that is residential, however I would want to keep my freedoms (access to my music, animals, nature, ability to leave if I need a change of scenery even if it means going with someone, access to my positive coping skills, access to my social supports and the community). I would want access to supportive and trained people at all hours of the day and night (because let’s be honest, most crises don’t keep themselves to a schedule, so if one arises, I want to be able to deal with it appropriately in the moment); a holistic treatment team (medical, psych, yoga, animal therapy, arts and expressive therapies, CAM) that takes my input into account and helps me implement my ideas (as appropriate and available); a safe environment where added supervision is available, but personal choice is also a key component; staff that maintains a level of compassion even if I get super annoying and needy; availability for staff to decompress and engage in self-care as needed; down-time for myself to regroup from dealing with something very heavy without the threat of having all the support taken away just because I seem better in the moment; people who are open to challenging me on my trouble points but also understanding of places I may be stuck; flexibility in treatment plans; openness to new ideas and new ways of doing things; limited judgements on how I present and a willingness to look at what may be underlying my symptoms/presentation; freedom from stigma around any particular symptom, behavior, or mood-state; people who listen to and hear what I have to say; people with patience around helping me figure stuff out; people to help me build a vocabulary and a method of expression for things I cannot adequately express; people who are willing to sit with me through challenging times, and gently insist that I get through the triggered symptom to find out what’s “on the other side” of it (not simply implement grounding at the first sign of distress, because I have recently found that there’s important stuff on the other side of a dissociative episode or a flashback); catering my treatment to me as an individual, and respecting me as an individual with certain likes and dislikes; going at treatment with “kid gloves” knowing that sometimes things will get way worse and way more challenging before they get better; having a treatment team that is ok taking over when my judgement goes south, but still open and receptive to what I am trying to communicate… Also an openness to “thinking outside the box” and coming up with new treatment ideas if the current ones do not work. Also I would include a transparency in all treatment methods, with access to everything by the client, and ultimate veto powers by the client.

Therapy sessions would be daily, and for maybe 90+ minutes to be able to tackle the harder stuff, then have the therapist available later in the day as needed to address what comes up. Arts/expressive therapies would be daily, animal therapy daily, visitors allowed daily with housing for family either on-site or nearby as needed, assessments to figure out what is helpful, and what might be helpful, organic treatment plan that evolves with new developments. “Family” therapy available (with whomever is involved in the person’s life), ability to return to treatment as needed, creation of “safe spaces” to help with processing things, personal choice around negative coping skills until the person is in a place to change them, but with the stipulation that they must be reported immediately and checked out as necessary, and taken on an individual basis, with constant monitoring and revaluation. I understand this is a huge liability and highly controversial, but it’s something I feel strongly that an element of personal freedom makes a huge difference in getting over it in the long run. Teaching accountability and responsibility around choices would be a huge component. I know I can walk away from something much easier if I have a choice around it than it I am simply told I cannot have it or cannot engage in it. It’s like the concept of thinking about a yellow school bus when someone tells you not to think about it; you will think about it more, and likely obsess over it. If negative coping can happen in a safe environment with buffers to ensure overall safety, I think it would go a long way to helping a person turn away from those negative coping skills in the long run.

It would also be standard of care to always look at every symptom, no matter how un-related it seems, and not discount any “medical” issues that may arise simply because I am there to work on psych issues.

I would prefer this to be with easy access to secluded nature and the beach, because that just makes me happy, but I guess anywhere with access to nature and water would be good…

It would be incredibly expensive, and incredibly intensive, but I think it would work for me. A girl can dream, right?

So, if you could design your ideal treatment based on what has and has not worked for you in the past, or what you have seen work or not work for others, what would it be?

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therapy today (really long-winded… sorry)

As much as I was dreading today’s session, it actually went ok.  I was able to tell TL that I seemed to have developed a lot of anxiety around therapy. I was able to tell her that I was in no way shape or form interested in having to be the one to continue to seek out additional services for myself (she pictured it as being “empowering” while I simply see it as a chore.  People here don’t like to return calls, answer their phones, or generally be helpful in any way when it comes to a client securing services for herself. I was a bit snotty about it, for which I feel like an ass, but I was able to let TL know that I was really tired of phone calls and playing tag with people. I was tired of begging for help for myself, and I just had zero energy or motivation to do any of it.  She seems ok with being the one to make the calls after we each explained our positions on the subject… I just wish I hadn’t been such a jerk about it)… I had hoped for some more structured and therapeutic groups, but apparently she is ok with simply having social things going on.  I told her I was not likely to go to many of them, as I had done that search myself and come up with little that seemed interesting.  I was not able to tell her that I really need something with more accountability, someplace I would be missed if I didn’t show, and someplace I could be more genuine (less “smiley-happy-normal-chick” and more of the “I-really-hate-the-world-and-myself-right-now-chick”), and find more support… She even asked if this was the kind of “extra help” I had asked about, but I wasn’t able to be honest about it.  I think part of me is still really scared about what that may lead to.  I’m still really bent on not wanting any reason to be inpatient here, especially when all they do is trap you and drug you. There’s no therapy, no support, and they treat you like you know nothing about anything.  Currently, I need more therapy, not less…

We then switched gears and TL plowed through the rest of the intake packet that I am assuming she is under pressure to have finished asap. Most agencies give therapists a month in which to complete them, and this would be the end of said month.  I say this not only because she was pretty bent on finishing it, but also because she was willing to stay nearly an additional hour to make sure she got through it all.  I’m really hoping she did not have another client in that time slot (I doubt it, because she was aware of when and how far we were going over time).  She tried to get some goals out of me, but I think I spaced. Had I been thinking more clearly, I would have identified wanting to deal with the loss of De (and other losses) as one of my goals.  I would have also told her that I need help keeping afloat at this point. She suggested animal therapy, and we covered the expressive arts therapies possibilities too.  She is open to focusing on some art therapy activities next session. She also asked about music therapy (which I said I was open to, though not all that sure what it entails).  We talked about my personal goals in life, which brought up a way to try to convey how hopeless things feel at the moment.  She also asked about how things had gone in school, and when I felt that things changed.  I realized that (at least in the moment I was speaking about it), I did not feel any connection to any of my accomplishments.  I had originally said I did not remember them, but that wasn’t accurate. They simply did not feel like my accomplishments.  I told her about promotions at work, excelling in school even while I was falling apart. She countered that I clearly had remembered them, because I spoke about them to her.  I had to clear up that they did not feel like things I had done, though I know of them because of my resume, my transcripts, and people’s stories about my successes.  I wasn’t able to pinpoint the emotion behind it at the time, but now I recognize it as feeling like a fraud.  Looking back, I feel like I must have cheated, or had someone take pity on me to be able to move ahead.  I don’t see how any of that could have come on merit…

We talked about a bunch of other stuff too, but I don’t totally remember all of it… too mundane I guess.  We ended with her reminding me she needs to ask about my safety (I had disclosed suicidal thinking and planning in our first meeting, and since then she does a safety check-in each time).  I felt like I was watching myself talk to her from behind a curtain.  Words spilled out of my mouth that I had no intention of uttering in her presence… It was very disconcerting (actually, it happens a lot with her. I tend to say more than I mean to say, and feel like I have little control over what comes out). I not only admitted to a plan, but told her what it was(?!). She checked in on the barriers to that plan, and I was honest about them. They are some very real barriers, and likely will not disappear any time soon.  I admitted that since I came up with the more solid plan, the urgency to follow-through had dissipated.  I think it’s just a “security blanket” of sorts at the moment. I know as long as the option is there, any overwhelming situation can be escaped.  If that option is gone, everything feels a whole lot bleaker and more hopeless… We ended with an appointment made for next week, and a plan to try to get me to that Yoga class on Wednesday… I’m currently feeling very resistant to the idea, but things may change by Wednesday.

I really miss having the ability to write after session and have my therapist read it before the next time we meet.  I keep thinking I want to bring it up to her, but it’s another thing I am writing in a reaction to on her part, and it will be rejection (mostly because I know that there is little out-of-session contact allowed/encouraged at the agency, and I know all written communication must be filtered through the supervisor. I’m not sure I want 2 people having access to what I write, especially since I don’t know the supervisor). It made things easier with De though.  It gave me a way to be able to express things I wouldn’t have been able to speak, and to process things at my own pace rather than within the hurried hour.  I might bring it up to TL at some point, but I fully expect to first hear “I will have to talk to my supervisor” and then hear “it would not be appropriate, see if you can bring the important stuff in with you the next session”… :/  …back to really missing De again.  I had told TL that I did not think there had been one day in the past 2+ months where I had not cried. It came up in response to something that made her try to tell me crying was ok, and can be healing… She seemed a bit incredulous about the statement, as if it was impossible for me to be that depressed (because I didn’t present that way to her most of the time? because that level of depression for that long is pretty uncommon? I don’t know)… At the end of the session, she brought up the fact that I had mentioned Ativan was the only thing that seemed to really help (especially lately). She asked if I would be interested in meeting with the psychiatrist at any point in case I was interested in getting a “more thorough evaluation”. I had told her that I had met with the guy once, and I was under the impression that he either could not or would not prescribe the Ativan to me, and that he hadn’t really been helpful in coming up with anything else.  She pushed a bit, but seemed ok at leaving the idea to marinate for later.  I had told her early on that meds and I do not get along very well (much like DBT and I). I reminded her that even the Ativan only worked because I had not taken it with any real regularity over the past 3 years.  I would like to have more on hand because it helps immensely with the flashbacks and impulsiveness, but I highly doubt that the ARNP (he’s not actually a psychiatrist, but a psych nurse with prescribing privileges) would give it to me. Most doctors will not prescribe benzo’s unless they know you, and know you do not have a drug problem.  Even on the inpatient unit, the psychiatrist initially refused to prescribe me any while I was there.  I had to beg him and underscore that I was ok with him not prescribing anything for after discharge, but that I really needed it at the time to help make my stay more manageable… It’s not a drug often used to calm flashbacks or impulsiveness, but it is one of the only fast-acting meds that can dull all of that for me.  I wouldn’t mind talking to this guy if  I thought I could get a script from him for it, but I doubt it. And I really don’t want to have to go through the hassle of trying to remember all the meds I have tried over the years, and all their out-comes.  TL suggested that he may be able to suggest something I have not yet tried, and that it may work wonders.  I stifled a laugh… I had tried every drug and class of drug that they even remotely thought might work to stabilize me back when I was in the hospital more than I was out of it.  They had come to the conclusion that I was hopeless and the only course of action left to take was ECT… I refuse to go down that road again…