Q. I have been diagnosed as Bipolar II, PTSD, and Borderline. I have been in therapy for 10 years with the same therapist and he isn't helping me anymore. I feel that my treatment has gone stale. I have been hospitalized numerous times, 6 times in the past year alone. My Psychiatrist and my Therapist seem to argue over what type of treatment I need. I feel like a child caught in a custody battle. I explained this to them both and now I have to see an expert in trauma disorders for a consultation as to what type of treatment approach will be beneficial.

I am scared to do this because I feel that I am being drug along into another 10 years of therapy that won't help. I am scared that I have a lifelong sentence of being miserable and that there is no future for me. Then I am also scared of change for the better. I try to tell myself that change is good, but I feel that I am comfortable in my misery that I should stay there. This has made everyone who works with me see me as "treatment resistant." While I don't feel I am, I can't convince my team that I'm not.

What can I do to counter my own self-sabotaging behaviors in order to get the right treatment? I have tried cognitive restructuring of my thoughts but it hasn't helped. I really don't want to be stuck anymore, but I'm scared of the unknown. My Therapist doesn't help me in this area. I feel like I need to be "pushed" more, but my Therapist tells me that he won't do that since he wants the therapy to be around my agenda and not his. I've tried to tell him that it's not working but he turns it around onto me and my resistance. My Psychiatrist is helpful but her boundaries are really strict with me so I am unable to see her (or talk to her) except for 15 minutes every week. I will go see the specialist, but how do I trust that the treatment approach he recommends is right?

 

  A. You can't know whether his treatment recommendations are right. It's just another opinion about how to proceed. In the end, your recovery has little to do with the psychiatrist, the therapist, the second opinion, or the type of treatment. It sounds as if many tools have been given to you, many issues have been discussed over the past 10 years, but you continue to think and behave in the same manner. For example, you indicated that you tried cognitive restructuring but it didn't help. Cognitive restructuring doesn't change you, it provides you with yet another tool to turn to and use when you are faced with difficult emotions and experiences. If you choose not to use the tool that is your responsibility. You also indicated that your therapy has gone "stale". What that usually means is that the therapist has discussed with you all the strategies s/he is aware of to help you and there is nothing left to talk about. It is unlikely that 10 years of therapy can go by without having discussed a ton of strategies to cope and improve your functioning. I'm not sure if its resistance. It may just be your sense of personal responsibility. You, not the MD, the therapist, the trauma specialist, or anyone else for that matter are responsible for your treatment and your outcome. If you don't agree with the treatment recommendations, go somewhere else. If you don't like your MD's boundaries, go somewhere else. Your treatment primarily depends on you making healthy choices.

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