Tag Archives: iop

IOP fail

Wow that was triggering. Not only did the staff not have it together (no one knew why I was there or where to send me), but it’s on the second floor of a locked psych hospital. I needed to be buzzed in the front door, leave my belongings, buzzed in through another set of doors, buzzed up the stairs… it was worse on the way out. There were 5 locked doors to get through that way.

Over the phone I was told it would be a 2-hour appointment: first filling out intake paperwork, then a meeting with the program director. When I got there, I learned they expected me to stay the whole first day. I mentioned that I needed to go after 2 hours because that was all I had alloted per the phone conversation last week. It was also all the time I paid for at the parking lot…

There was a ton of miscommunication and misunderstanding before I even set foot in the door. The groups were rowdy and loud (a huge trigger when I’m already anxious), and everyone spoke over everyone else. Oh, and the only bathroom was a single occupancy room with entries from both group rooms. I hate going to the bathroom anyplace but home. It makes me very anxious. Having people know and hear me pee? Even worse…

I was so glad to be able to get out.  There is no way in hell I’m returning there. I left 2 hours ago and still am trying to center & calm myself. I keep looking around the house to remind myself I’m home.

I left TM a quite panicked message upon leaving, begging her to tell me I never had to go back…

I think I need to call them. I will tell them I changed my mind, and ask them to shred my paperwork… the move should be enough of a distraction at this point (I hope). And I won’t bug TM after tomorrow either. She shouldn’t have to put up with me just because this IOP was more triggering than therapeutic…


Dear TM…

Dear TM,

Now you are seeing the hopeless mess that I can become. I don’t like that you will remember me this way. I don’t like that we are ending on this note. I’d prefer you to think of me as someone who can figure shit out and make it in life (coz someone needs to believe that about me. I certainly don’t)…

I’ve put up walls b/c I need you to be a stranger right now. I need to be able to leave without feeling completely crushed about all the losses. It’s not just you I have walls up around. It’s the house, and the state, and mom, and the dog and cats, and art time with my friend, & everything… I’m only going to allow myself to miss the beach. That is all. Everything else is too raw and too painful.

I still want to ask if it would be ok if I called you once I’m settled again… I was going to ask if I could call you on the anniversary day, but it will end up being the day we leave. I will need to concentrate on driving and hanging with the wife… I hope she knows she will have to do the first leg of the journey, the one that gets us out of the driveway and away from this neighborhood. I’m not sure how to say goodbye to all this…

Maybe the IOP will work out? I’m not getting my hopes up, because I don’t have faith in them billing for copays, but at least I can go to the intake without having to pay anything that day. Then we can go from there. The little kid in me wants to keep seeing you as much as I can before I go, but the other part of me sees the heaviness of the depression and knows I would be better off with more support…

I really have no idea what I’m doing, but I know I will come out the other side. I always do.

Please don’t actually hate me, just maybe let me think you do for the moment.

Pieces,

sj


doh!

I forgot my new insurance has high copays. Trying to check with the hospital whether or not they can bill me for that. If they can’t, it’s no longer an option. I can’t afford $120-$250 a week for a program (depending on the number of days and level of programming, I’d either be paying $40/day for 3-4 days of IOP or $50/day for 5 days of PHP)… I can barely scrounge even $20 at the end of the month after bills and obligations, forget what it would cost for treatment.

I had hoped the hospital program would call me back today so I could cancel early if it’s going to cost that much, but the lady didn’t return my call. She’s supposed to call tomorrow to confirm my attendance on Monday, so I will ask her then.

On a positive note, L signed the lease for the apartment earlier today. It’s more and more official. I need to start getting moving on packing and paring down our stuff…

 


damn therapy…

Our session with J was rough, as expected, but in a different way.  I came away feeling angry and invalidated.  I think I need to tell her to let up on the grilling about whether or not I feel like I am getting anywhere in individual therapy.  It’s a process… Trust is a process.  It takes time.  We’ve been seeing J for several months, but I have only been with De since mid-August.  She also said to call the IOP back and ask them for their reasoning behind not letting me back (after all, I did not act on my thoughts/urges, but I sought out help).  She thinks that the rule is stupid.  IOP is supposed to be for the added support, and supposed to be there as a step-down from an inpatient stay.  I was up-front with them about the suicidal thinking when I did my intake.  They knew that was an issue.  I did not make a move to act on the feelings, but I’m suddenly too much of a risk for having to have gone inpatient… J says she would go to bat for me about it with them, but she’s guessing it would be better coming from my individual T instead.  I told her I wasn’t sure I wanted to bother… I don’t like having to beg for help and having to convince someone to provide services.  Yeah, they are the only local place that takes my insurance, but… I dunno.  I’ll see what De thinks. I Just don’t get why I should have to fight for something 1)when I feel like crap and have no motivation, and 2)that I don’t feel worthy of.

J also said that L & I needed to be more direct and say things in the moment more often.  I disagree.  I think that leads to misunderstandings, needless fights, and a lot of hurt feelings.  So F-you J!  Grrr!!!  I’m kinda glad we don’t have her next week…

I see De tomorrow.  Hope it goes well.  I know my walls are up out of fear.  I don’t want to be referred out, but I have a feeling I will be (though that just may be the fear talking).  I’m trying not to get my hopes up, or to want to be too open.  I had mentioned that to J earlier, and that’s when she launched into her lecture on therapy being what you make of it.  

Anyway, came home today and tried my hand at sculpture again.  I haven’t done it in YEARS, so it came out pretty crappy.  Also, the Original Sculpey is super-soft and sticky, which makes it harder to work with (at least at this temp).  My piece ended up flopping over a bit, and it took forever to cure (tho I’m pretty sure somewhere the directions say not to do it in the toaster over, but I didn’t want to have to unpack the big oven for a few small pieces).  I left the sculpture really rough in hopes of being able to add more detail with the Dremel tomorrow.  I have never carved anything.  It will definitely be an adventure.  I took some pics of it tonight just in case I screw it up badly tomorrow.  I’ll only post it when it’s done though (or if I mess it up really badly).  There’s just something about some works that you can’t them show off before they are completed…


Updates

I will be seeing De on Friday.  She did not say she was referring me out over the phone, so I’m hopeful to still be able to see her.

I made it to a walk-in clinic today for my ear.  The breaking point was when it hurt a lot to try to listen to music this morning (without even trying my headphones). I have infections in both ears, as well as some gunk going on in my chest – fun times.  My insurance has not totally kicked in yet, so I can’t get any of the scripts filed.  The state told me to call back Friday and see if I met my deductible.  I hope so, because I could really use those ear drops.

We go to see J tomorrow for couple’s therapy.  I’m thinking it will be an emotionally tough session.  L resents when I chose to go inpatient.  Intellectually, she knows it’s better than the alternative, but she still feels left alone.  Intellectually, I know that she’s more mad at the situation than at me, but emotionally I feel like I again cannot get things right… my hospitalizations are turmoil on so many levels.  I’m glad we have J to talk it over with in a way that feels more safe.  Both L and I retreat into our intense emotions when talking about this stuff.  And I’m scared that this time she said she was getting burnt out on my depression.  I totally get where she is coming from, but I also fear the consequences. 

Losses (and the threat of losses) from my break-downs make it difficult to follow through on asking for help, let alone asking before it’s too late.  That, and I go very quickly from “managing” to “complete mess”. There’s not often much time for me to realize I need help.  Pair that with not really knowing what I need in terms of help, and I end up waiting until things are at the “drama” stage.  My emotional meltdowns pick up speed faster than a luxury sports car let loose on the Autobahn (sp?).  I need to figure out how to change that…

Anyway.  As long as I keep moving (and can sleep through sunrise), the hopelessness stays at a slight distance.  If I wake up before the sun, or stop occupying my brain, or if I’m reminded how useless my insurance is, the sadness and hopelessness starts to seep back in.  I can’t allow that right now.  The holidays are approaching.  I want to be here for that.  Also, De will be less available at that time, so I need to keep it together if I want to stay out of the hospital for New Year’s…


went to IOP.  was meh.  feeling more meh.  😦

losing hope fast.

_____________________________________________________

I am lovingly reminded by L that I need to ask for help; that people can’t read minds… only I am afraid to ask, so I hope they can read my presentation…

IOP was unproductive because I could not bring myself to ask for help.  I was really triggered by the second group, but I was too worried about saying the wrong thing (or taking the group off track) to open my mouth and say so.  I thought of asking to meet with my case manager, but I chickened out. I was afraid that if I sat in a room alone with someone, I may actually open up… I was afraid of what that would bring.  So instead, I am here feeling shitty.  I’m shutting my wife out because I don’t want to admit even to her how hopeless I feel.  I’m torn between begging for anything that may even remotely help, and hiding away in myself so I don’t splatter on others when I implode (it’s no longer a question of “if” but “when”).  I need to make it through the rest of today and tomorrow.  Wednesday I go back to IOP and try again.  I have told myself that, if I still chicken out on opening up there, I will stop by De’s office on the way home.  It may be easier to ask her for help than a complete stranger.  She had opened the door to that help last week, giving me permission to just show up if I needed to.  If this continues, I will most certainly need to…


crushing weight (triggering?)

There’s a huge weight in my chest.  It feels like a black hole is ripping me apart from the inside…

I need to make it through the weekend without a total meltdown.  I start an IOP on Monday.  I promised I would give it a try.  It’s just so far away.  I don’t want to do anything or go anywhere.  De had conditionally given me permission to stay in bed if it meant I would be safe. Even bed is no longer bringing relief, but it’s better than outside of it.  I want to cry but the training from childhood is keeping the tears in check (maybe if I could cry I could release all of this).  I used to cut instead of crying – tears of blood… But I am not allowed to cut, so the crushing weight stays.  The tears are stuck in my eyes.  Nothing helps.  Music works to help the emotions go in waves (I tend to get stuck without it), but they still constantly cycle around.

De said it was ok to ask for extra help if I needed it.  She said she wanted me to be able to ask for inpatient if that was what would help.  I can’t bring myself to believe her.  I’m afraid it would be the tripping point that sends this spiral out of control.  I really don’t want to lose her.  There’s a lot of care-taker transference going on with her for me.  So far, those I have felt this way about have disappeared from my life.  I’m desperately trying to keep that from happening with her.  I’m afraid if I ask for more help than even the IOP, I will lose the last bit of glue that is holding me together.  I have a past filled with out of control spirals tripped by a hospitalization.  I don’t want to go there again.  I’m trying to hold it together, but it’s SO hard right now.  I don’t want to admit to feeling this bad.  I don’t want to admit the extent of the hopelessness and despair… and I really have no idea what help a hospital stay would be other than physical containment.  I cannot have my most effective safe coping skills there with me (my wife, my dogs, my music).  They force daily meds (something that makes me 100’s of times worse – yes, there is worse than this).  I lose all control when I’m trying so hard to hang on to it.

Every time I think there’s a glimmer of hope (got disability & Medicaid), there’s really just nothing much more it helps with (very limited places take Medicaid, and none of them offer more intensive therapy than an IOP for mood disorders.  No one that specializes in trauma takes it…).  I was hoping the meditation class would bring some balance today, but it didn’t help.  The topic for today’s walk was possibilities.  Count on a depressed brain to turn that negative…  Being in nature helped a bit.  My instinct was to find a secluded place in the park, but I was unable to do so.  The rain was nice (at the restaurant, we sat at a table that was partially uncovered.  The staff was very worried that we were getting wet, but I kept assuring them I did not have a problem with that.  They kept wanting us to move under the roof, but I liked the rain).  I brought a rain coat, but I just wanted it to pour down on me.  I sat next to the water out in the park.  I begged Mother Nature to open the sky.  She just sent a mist.  L challenges her and she gets the challenge.  I beg for more rain and I get a misting… I need L’s power… She complains that the ocean is too still, and in a few minutes the waves are large.  She complains there’s no mud to play in and in the middle of the hike we get stuck in mud up to our knees.  Today she laughed that the cup I placed under the drips was not catching any water.  Within 30 seconds, the rain came harder and the stream of water filled the cup… I envy her power (or the coincidence of the occurrences).

My heart is broken.  My head is broken.  I’m broken.  It never gets better.  I’m just so tired of all this.  Must make it through Monday…


Emotional roller coaster

As distracted as I was able to get for a good chunk of the day, the night brings with it the return of the depression.  My chest is heavy and tight.  There’s a definite weight on my heart.  I’m tired, but having trouble sleeping. I’m worried about the weekend and anxious for Monday. 
I went to the orientation for IOP today.  I ended up arriving late because for whatever reason my head was convinced I needed to be there at 1, not 12. I realized my error when my phone alarm went off at the 10-minute mark (in the past, I used to set the notification to 15 or 30 minutes, but I got out of the habit for some reason). I called them asking if being that late was ok, then flew out the door.  It ended up being a quick overview of the rules and expectations.  It did serve to make me a bit more comfortable. I’m just still lost as to how I will get there.  I can take our car on Monday, but will need to arrange other transport after that (too far, too much gas,  and L needs the car for work). The place seems ok and the people seem nice.  I hope that first impression holds true… and I hope the program is actually helpful. I think some of tonight’s anxiety is a rush to get the first day over with.  The chest tightness I’m associating with anxiety, the same with the shortness of breath.  I need to dig up my inhaler, but I’m too lazy to move from bed just now. Maybe in a few more minutes?

I find my thoughts continually dipping to the darker side of things.  It shadows my entire world even when I’m supposed to be out and distracted. There was a restaurant giving away free food at their grand opening.  We went and enjoyed the food, but everything was tainted dark.  I tried to focus on the positives (the wrap was really yummy). I repeated over and over again that I was enjoying the time with my wife (which I was) but it was not enough to drown out the whispers.  I’m hoping tomorrow will bring more success: we have our second meditation group meeting at the Japanese gardens.  I really like the place, but I’ve sucked at the meditation exercises we were supposed to do.  I will put more effort into it tomorrow…

This struggle is so tiring.  I’m ready for the break.


speaking to SJ’s panic

I saw De today.  It was good.  She helped ease some of my fears.  She spoke to the scared little kid in me who was terrified of losing the connection with her.   She did most of the talking, but it was stuff I needed to hear (SJ busied herself coloring a minion).  I was able to ask the main questions weighing on me.  She was able to explain that a discharge for being unstable would be looked at case-by-case.  We will be playing the next few weeks by ear.  She underscored that my safety was her top concern, and she wanted me to feel comfortable asking for help as needed without the fear of immediately losing the relationship.  She was very careful not to make any promises she would not be able to keep, but she was able to promise a termination session if it came down to it.  She explained a bit better what the bounds of that decision would approximate, which gave me a bit better idea of the whole process.  She also agreed we could do more art either in the art room, or her office if the art room is not available… I found out today she has play dough in her office… We may need to break that out next session.

De also seemed relieved that I am willing to go to the IOP (Intensive Outpatient Program – 9am-1pm, three days a week for about 8 weeks) and give it a shot even though it’s not exactly what I’m looking for.  The holidays will be dicey for scheduling, and she will be away for 2 weeks between Christmas and New Year.  She was quite up-front about being relieved that I will have the added support of the program during the time she will be gone.  I kinda feel bad.  I never meant to worry her like that.

Because of our conversation, I was able to admit that the hopelessness is still very heavy.  She encouraged me to ask for whatever help I think I need. She wants me to be able to ask for inpatient if that is something I feel I need at any time.  I’m going to give this IOP a try, and see how it works out.  I hope it will provide the safety net I am so desperately seeking.  I am a bit hesitant about trusting anyone there with my hopelessness.  I have been misunderstood/over-reacted to in the past by people at IOP’s which lead to multiple involuntary hospitalizations (and that was in a state that had stricter guidelines for involuntary commitment.  here, you just have to “appear to have a mental illness” in order to be able to be involuntarily held for up to 72 hours for psychiatric evaluation.  That’s a really broad phrase open to much interpretation… SCARY!).  I worry about saying things the wrong way (as is often the case) or confessing to my hopelessness and being hospitalized because of it.  To help with those fears, I am filling out paperwork that gives my wife power to make decisions for me (and if she is unable/unwilling, my mom gets the honor) in case they declare me “incompetent to make decisions” for any length of time.  I know both L and my mom are on the same page as I in terms of my mental health treatment.  I am confident they would support any decision I ask for.  It’s scary how paranoid that makes me sound.  However, having been in battles regarding my mental/emotional competence in the past, I want to make sure all my bases are covered.  One of my greatest fears is being forced into a treatment I do not want.


Some relief?

The appointment at the IOP went well, I think.  I have an orientation on Friday and start Monday.  It will be focusing on the depression and anxiety.  When I talked to De to update her, I told her they actually recommended seeing an individual therapist while still doing the program.  She said that it might work out really well, and we might be able to keep working together on the trauma stuff with the added safety net of the program.  I think she will check it out with her supervisor, and we have agreed to take it on a week by week basis.  Her concern would be possibly overdoing the therapy.  I told her I have been able to work well under those conditions in the past, and the added support is good when dealing with the trauma stuff.  I hope it works out.
The only issues with the program is transportation. I have to figure out how to get to and from the program.  It’s tough with the distance and us having only 1 car.  The guy gave me 2 ideas for help with that, but was not too specific about who I should talk to and if it would really help.
I almost cried when De said we might still be able to work together.  When I left yesterday, it seemed like that would not be a possibility.  I’m trying not to get my hopes up too high, but… phew!
Glad I did not get to a place of having to go inpatient.  That would have definitely messed up my chances for continuing with De.


The ramifications of falling apart

De and I came to the conclusion that I need a higher level of care at this time.  We are working on finding something for me, likely a day program locally.  My options are very limited (most intensive programs are focused on thought disorders and not mood disorders. There is nothing that accepts Medicaid that focuses on trauma).

The drawback of needing more intensive treatment: I lose De for a minimum of 6 months. Even though she said we would plan on meeting again in “a few months” the likelihood of that is slim. (I think she will see me until I get in somewhere, but I’m not 100% sure of that). The organization she is with subscribes to the policy of not seeing clients in active crisis under the theory that stability is needed to tackle trauma issues.  While I see the value of this, I find the length of time a bit stupid.  I (intellectually) know why it is there, but I still don’t like it.  All the abandonment stuff is coming up again, and I really don’t want to find anyone else to work with.  At this point however, I have no choice.  At least I can see her Thursday.  Had tonight not been so busy, I doubt I would have been allowed to leave her office for home today… the hopelessness is pervasive and loud.  I have not been able to quiet it despite my best efforts. I just don’t see the point when everything screws up in the end.

I called a bunch of places trying to own up to financial obligations only to find I did not muster the energy in time.  I continually screw things up for myself. I never learn. It sucks… it will never turn out ok.

Anyway, I have an evaluation appointment with the only IOP-level program in the area that deals with mood disorders and accepts Medicaid. I’m worried because it is far away, and they say it’s an average of 8 weeks at three times a week.  I would need help with transportation and I’m not sure they offer it.  If they can’t help out, I need to search for something else.  The resources here are very, very limited. It’s hard enough that most intensive programs offer little by way of therapy, add to that the lack of available Medicaid programs and it all looks very hopeless.  The only intensive trauma-focused program locally had a Medicaid scandal, so they no longer accept it.  I really could use a program like that, but they don’t exist, so tough luck.

I just want to sleep. I’m so tired of all of this. I couldn’t stay stable, so I fucked up things with De (and the potential for growth/recovery was huge there).  It’s all just crumbling… and I’m so tired.  Really hoping something works out. Not really sure what I will do for individual therapy after whatever program I go into.  I’m spent trying to open up again…

Couple’s therapy sucked tonight… It did nothing to make me feel better at all.  And I’m not sure if we addressed any of what needed talking about.  I know we talked for an hour, but I have no real clue what it was we talked about other than J telling me I needed to work at getting better… and that maybe therapy with De had actually come to an impasse.  I think it was just fear messing with me.  My head is terrified of dealing head-on with my trauma, so it does what it does best, and hits self-destruct.  But that also served to yank my support out from underneath me.  Brilliant job SJ.  Brilliant.  Now you’re just f*cked.