Comments From My Therapist

[yogini]

I've realized that whenever I tell my therapist that I feel fatigued from POTS, she asks me whether I'm taking a good multi-vitamin. I do take one, and I've told her this many times. If she's asking this question I feel like she doesn't understand the severity of our fatigue - as if it can be cured by simple vitamins....don't we all wish! This is despite the fact that I've told her there are many weekends when I don't have the energy to get out of bed.

Also, whenever I tell her I have a tachy episode, she always asks me whether I was really worked up about whatever I was doing. For example, I took a short day trip on Sunday and had some unexpected severe tachycardia. She asked me whether I felt anxious about going on the trip - which I wasn't In fact, I took the same trip 3 times last year and didn't have any problem...so I was walking along on my merry way when the tachycardia hit me from out of the blue...which is how it usually happens. I feel like her question implies that I'm worrying myself into a tachycardia spell, which isn't right and not what I need to hear. I'm already upset that my POTS has been worse over the past several months.

I've worked with this therapist for 2 years and overall I've been satisfied. But I'm frustrated because I've told her many details about my illness and I'm still getting these kinds of questions from her. Am I being too sensitive? I have a tendency to keep quiet - should I say something to her about this? Any advice would be appreciated.

[MightyMouse]

um, to me, (Just my opinion here) it sounds as though she thinks some of your symptoms are 1) controllable if you just took better care of your body and 2) somewhat related to you having anxiety or anxiety attack.

Nina

[Guest Eliza]

I have a doctor that I have seen for many years (not a therapist though) and I have noticed that sometimes docs just don't pay attention. They seem to be on "auto pilot" and just assume EVERY patient is the same. My opinion would be to (next time she says that) say "look......I have told you MANY times that I am taking my vitamins and that I am NOT becomming stressed out before these episodes. I REALLY need your help in these areas because they are troubling me greatly".

Sometimes you have to be kind og blunt to get their attention it seems.

I hope your therapist actually listens to you next time and realizes that you are "reaching out" for help and answers!!

Good luck!!

[mkoven]

I would definitely bring it up with her--esp. if you feel like she has otherwise been helpful. Can you bring her some literature that explains the difference between pots and anxiety--like it's positional nature? Standing up is not usually an anxiety-producing activity for most.

[Sophia3]

um...as long as your therapist is disappointing you, i would NOT KEEP QUIET about it... She seems CLUELESS about chronic illness.

Does she KNOW it's a GRAVITY issue with the tachyness?

Does she understand the blood is NOT DISTRIBUTED PROPERLY thus causing the FATIGUE??

If she does not understand, time to switch therapists.

Or lie on the couch in her office and have her take your BP and HR. Then stand up and let her see the HR ZOOM. I did that once when I was feeling lightheaded and we wanted to make sure I could drive home.

My therapist knew my HR would jump but when she saw it leap 50 beats, she was shocked to SEE THE NUMBERS...and SHE WAS UNDERSTANDING...but seeing the numbers can validate things more.

But your therapist seems to be DISMISSING your symptoms. either take in articles to ENLIGHTEN her or get another therapist.

It's not good to resent the way your therapist is responding to your symptoms and I would be annoyed if I were you. BUT I would make sure she has a CLUE about POTS. If she chooses NOT TO LEARN, can her.

Find somebody who RESPECTS your challenges.

[MomtoGiuliana]

If she is helping you in other ways with coping, I would let her know that this advice she is offering is bothering you and is not helpful, and see if she is open to understanding your medical condition better. Can you give her the DINET brochure or other article that explains POTS (probably you already did.)

It is funny how doctors like to give psychological advice and counsellors give medical advice. A counselor I saw at one point recommended some homeopathic treatments. Overall she was helpful, so I just ignored that, but it is annoying when professionals stray from their expertise.

It can be hard to find a good counselor. If she "gets you" in other ways, and is helping, I wouldn't give up on her.

[pat57]

I'm with Sophia

show her the numbers.

[Ernie]

Hi,

I would bring her a description of the disorder as well as a list of the symptoms and when she ask the annoying questions I would show to her and explain to her how I feel. I would repeat it several time until she gets it.

[doctorguest]

Your feelings are probably right - the therapist most likely does not understand the severity of fatigue or any other symptoms of POTS. Therapists are trained to deal with the "bread and butter" of psychology, i.e. anxiety/depression issues, not POTS. More likely than not, the therapist has not heard of POTS or if she has, then not in enough details. Familiar problems call for familiar responses - i.e. fast heart rate on a trip "must be" from anxiety in the therapist's mind. Perhaps what others suggested about sharing review articles on POTS may help to continue a good working relationship with this therapist. I would not be surprised if a different therapist has the same attitudes as your current one.

[pastordari]

I concur with doctorguest.

The therapist probably doesn't understand. She is dealing with her "usual" responses and doesn't get that you are unusual. I was a mental health social worker for a few years and you get into the routine of things and think all people with depression act like thus and so. All people with anxiety issues behave this way. For the most part the general categories work. When you are presented with someone with differing symptoms and issues it throws you a bit. It takes compassion and a willingness to work a little harder to understand someone who is experiencing an out-of-the ordinary illness.

I took my therapist some literature - make it brief, but pithy because you want he/she to actually read it. Or, you could once again discuss the symptoms with the therapist. Mine read the article and was interested to learn about what I was (am) experiencing. She was struck by how much of my symptoms that seemed to her to be anxiety were actually due to the dysautonomia. I do have some anxiety from time to time, but for the most part the anxiety is not the problem. Now, it seems the pendelum has swung the other way. She wants to suggest that "everything" I experience is bp or HR related or a med reaction. I am getting less attention to my thoughts and emotions. However, we have a 2 year relationship and she is really great. I can go through this with her because she is open to learning.

I would definitely discuss your frustration with the therapist. If the therapist isn't open to discussing your illness or her/his response to it then you need to move on. Of course, you will have to educate the next therapist and start all over with a relationship. . .

[runningshoe]

I feel so blessed to have found a psychiatrist who was previously an internist. With such a strong medical background he often teaches me about Pots issues. Unless the therapist is a M.D. (psychiatrist) he/she won't have all the physiological pieces of the puzzle.

[yogini]

Thanks guys and especially Doctorguest. I appreciate all of your replies and support!

I did some web searches into how/why to terminate a therapist - and none of the reasons that were cited (putting down you and your family, being egotistical, etc.) would really apply here. My therapist has been fairly normal, so I do think it's a great idea to give her some articles. I did have a hard time finding someone decent who accepted my insurance, so it'd be better if I could make it work.

Although my therapist doesn't have other patients with POTS, she does treat others with chronic illness. I'd have hoped she was a little more sensitive, as some of the issues (like fatigue) are not unique to POTS. I know POTS is pretty complicated - and I don't expect her to understand the ins and outs of it. But I do need her to understand that the main symptoms I tell her about are part of the illness and that I'm not causing or contributing to them. I think its a great idea to give her some articles to explain. I think I gave her some when we first started, but since it's been a couple of years I should probably do it again. We'll see how she reacts - I hope she'll be receptive!

My appointment is on Monday, so will let you know how it goes.

[flop]

Hi Rita,

I agree strongly with doctorguests advice that the therapist is trying to fit you into the same "anxiety" box that almost all of her clients with tachy and fatigue do fit into.

Have you ever heard the phrase "when you hear hoofbeats, think horses not zebra"? (i.e. horses are really common and zebra are rare) You need to explain to her that you are actually a zebra and your hoofbeats (symptoms) are not "anxiety".

You certainly need to talk to the therapist about how you feel. In therapy it is so important to build that relationship and understanding - how can that be if you keep your frustration a secret? Explain that being labled as "anxious" is often how a diagnosis of POTS is missed for years as the symptoms are so similar on a superficial level. Rather than being confrontational, perhaps try telling her "I know that the tachy etc are part of my POTS and are not caused by anxiety, what I would like you to do is help me work on how to cope with them when they occur, as my doctors currently can't find anyway to prevent them from happening".

Good luck on Monday,

Flop

[friday]

Well , I think this is definitely something you need to address with your therapist. If you can't talk to her about what you're feeling,. what good does it do you?

You said it best to us right here..only say it to her, "when she (you) ask me whether I'm taking a good multi-vitamin, I feel like she (you) don't understand the severity of our fatigue."

"I feel like her(your)question implies that I'm worrying myself into a tachycardia spell, which isn't right and not what I need to hear. "

And you can bring some P.O.T.S. information to educate her. if she hasn't been exposed to any solid information about P.O.T.S. it might be why she just doesn't get it yet.

I am lucky to have a great therapist. And I had seen her prior to getting sick physically so she knows me pretty well. Yet sometimes she says things that make me feel as if she isn't getting that it's physical. I kind of understand since POTS Isn't a common illness. But even so, I think if I was Diabetic and had problems from that, she'd probably check out whet what I was feeling was coming from an emotional place sometimes, or if emotional stuff was worsening the symptoms. The thing is when I feel like she is not understanding it's physical, I have to tell her.

I feel that If she says anything, regardless of whether or not it has to do with my illness, that's making me feel bad or like she doesn't understand I need to tell her. That's part of our relationship.

You might want to ask her point blank as to whether she thinks that your emotions are the cause of your problems. Not in a nasty way but just to know exactly where she stands. Ask her if she understands how debilitating it is for you. Tell her It' s important that you know she believes you are physically ill, because you are. And you need the support any person with a physical illness would need.

If she doesn't get all of this and doesn't' like you telling her how it feels when she says certain things, she may not be the right therapist for you. I know I couldn't stand it if my therapist said something that bothered me and I couldn't' tell her about it. It's not always easy to get it out but I do it assertively, not blaming, just telling her how I feel. And I probably do this every week. LOL because I'm so sensitive. She understands that.

But try to talk it about with her. Give her some good info, especially stuff that describes how debilitating this illness can be. And if you do have symptoms that are easily presentable show them to her. If you have a heart rate that speeds up 20 to 30 beats immediately upon standing show that to her. If blood pools in your legs and they turn colors after few minutes of standing still, show that to her. I did that with my GP and it made an impression. He got that it wasn't in my head, when he could see my feet turning colors.

Good Luck

[worththewords]

I think you should address this with your therapist and even how her responses make you feel. It would be a good idea to include a brochure or briefly educate her. I was told by a therapist once that her greatest learning experience came from when a patient being straight forward with her about whatever they didn't feel was going right. It's the only way to get things on the right track and create better understanding/communication.

[yogini]

By the way, I just wanted to clarify that I am prepared to end things with the therapist if she doesn't seem open, but I just wanted to try giving her some info first...

[Maxine]

Considering you have been with your therapist for over 2 years, it sounds like she might be worth working with in regards to educating her on all the various symptoms, and how they can come and go unexpectedly. There's loads of educational material all over the net, including this site---

Fortunately, I have been lucky with therapists. I still see two of them. I see a male therapist once every 4 weeks or so, and a woman about every 3 weeks. I love them both, but the male therapist does not participate in my insurance any more, so I have a larger co-pay. My husband and I go to the other one together to help cope with the everyday issues that come with chronic illness. She has been with me from the beginning, and ironically she is the one who was sure that I had something physically wrong and urged me to continue searching for answers.

Both are very open and understanding about my health problems, and in fact the male therapist said any anxiety or depression is secondary to my PHYSICAL PROBLEMS.

On a funny note.............Hmmmmmm........LOL ... I saw a therapist appointed by SSDI to check and see if I have any psychiatric problems, cognitive ect. With everything I have wrong with me physically, you wouldn't believe it----well maybe you would---- They said I have somatic disorder, and that my ONLY hobby is researching all my illnesses-----that are manifested in my mind. The report was rejected out of my SSDI file..........

Depending on the therapist, it could backfire taking medical articles, journals ect. to an appointment----

I sometimes wonder how nutty some of these therapists are. Creepy..........

Maxine :0)

[Mrs. Burschman]

Maxine,

All I know is that when I attended South Dakota State University (go Jackrabbits!) the weirdest people on campus were the psychology and art majors. No offense if there are any here!

Amy

[mattsmum]

Aren't you supposed to be openly honest with therapists? I would be quietly telling her she has nfi what she is talking about and to do a little bit of homework before next appointment and leaving behind some information. I hope you aren't paying for that kind of therapy.

[masumeh]

my two cents: tell her you feel she's unsupportive about your illness, and that you suspect this is because she doesn't fully understand the medical implications of Autonomic Nerve damage. Psychology, epsecially therapy, includes various schools of thought, orientations from which the practitioner or researcher attempts to understand the human experience. Some are socially oriented, some biologically, some cognitively, some behavioral, etc. Your therapist, statistically speaking, is probably eclectic (combo) or psychoanalytic (think Frued). It helps to ask about your therapist's theoretical orientation. It will help you understand her/his analysis of your feelings, thoughts, experiences. You always have to filter, you know...take the good, leave the erroneous or offensive at the door.

In any case, the therapist is there to support you....so let her know you don't feel supported in this regard.

-masumeh

[yogini]

Well, I did give some articles to my therapist on Monday. I told her that I when I talked about my health that found that some of her comments were not helpful and gave her some examples of this. She told me she knows that my symptoms were caused by my health, and that the only thing she found confusing was she couldn't tell whether the symptoms were caused by POTS or the medications I was talking. Funny, because I'm always saying this to her myself - that I hate taking BBs because they cause low BP and fatigue, the very things I'm trying to get away from. I'm not sure whether it matters why the symptoms are happening, since I don't have any choice but to take the BBs. So I didn't quite understand her point. She did seem happy to get the articles and thanked me for them both when I gave them to her and again at the end of the appointment.

So, all in all, I'm not sure what to make of her response - though she at least seemed receptive to reading the articles. We'll see what she says next week and how she reacts when I mention my symptoms from now on...

[MightyMouse]

good for you for being assertive about your health. Nina

[friday]

Well, I did give some articles to my therapist on Monday. I told her that I when I talked about my health that found that some of her comments were not helpful and gave her some examples of this. She told me she knows that my symptoms were caused by my health, and that the only thing she found confusing was she couldn't tell whether the symptoms were caused by POTS or the medications I was talking. Funny, because I'm always saying this to her myself - that I hate taking BBs because they cause low BP and fatigue, the very things I'm trying to get away from. I'm not sure whether it matters why the symptoms are happening, since I don't have any choice but to take the BBs. So I didn't quite understand her point. She did seem happy to get the articles and thanked me for them both when I gave them to her and again at the end of the appointment.

So, all in all, I'm not sure what to make of her response - though she at least seemed receptive to reading the articles. We'll see what she says next week and how she reacts when I mention my symptoms from now on...

Glad to hear what happened. at least she accepted your criticisms ..although you seem to think she wasn't happy about the literature..she should be interested in reading it though being that she is talking to a person who has this problem. But like you said, see how she is after this...Good Going!

Susan