It’s too easy to bail on a therapeutic relationship rather than resolve the conflict. There are all sorts of conflicts that come up between psychiatrists and patients. There are disagreements about diagnoses, medication choices, side effects, listening style, or just basic misunderstandings that occur in the course of human conversation.
Too many of us patients get into the pattern of doctor hopping rather than conflict resolution. A good relationship with our psychiatrists happens not because we have Dr. Perfect but because we resolve conflicts.
Therapeutic relationships are the perfect places to practice learning to speak up and resolve relationship challenges. However, most patients interpret a disagreement with their psychiatrist as an invitation to bail on the relationship. After all, why should I have to pay someone to be in conflict with them?
This is my proposal for sticking it out during a rough patch with your psychiatrist. I have had some serious conflicts with my psychiatrist over the years. Each conflict terrified me. I was certain the discord meant I was either going to be dumped or I might have to leave. In 23 years, neither has ever happened. What has happened instead is that I’ve gotten successively better at speaking up for my needs, and he’s gotten successively better at adjusting his approach to me because of those needs.
I think of it like this: He has hundreds of patients, but I only have one psychiatrist. Making the most out of that relationship is as much my responsibility as it is his.
A perfect example of a communication conflict that occurred between my psychiatrist and me happened a number of years ago. I sat in his office desperate to tell him about a recent PTSD event. The memory of the trauma played over and over in my head and had reduced me to a quivering, sobbing, jelly. I tried to compensate for my terror by fortressing the entire house. I barred doors, wired shut window locks, and kept protection near me in case my tormentor reappeared in my home. I stayed up all night, vigilant for the assailant. When dawn emerged from night and I realized I had found a new way to protect myself, I intended to burrow into my home every night. I was triumphant but also exhausted by my new protection strategy. As the days dragged on and I remained hypervigilant and terrified despite the new security measures, I knew I needed my psychiatrist’s wise council to help me resolve the problem.
At my next appointment with him, I tried to convey the complex situation with vague references, half spoken facts, and a lot of staring at my hands. He seemed unfazed and answered my presentation with, “You seem to be doing well and I know you have a hard time when things are going well.” I was devastated. I thought, how could he think I was doing well when I’m not sleeping. I’m barring myself in my house every night, and I’m shaking in fear as soon as the sun sets?
I dashed out of his office, dove into my car, and wept. As I calmed myself down, over time, I realized that in my conversation with him I never once told him I had turned my home into a fortress, or that I hadn’t slept in two weeks, even as I kept protection by my side. I’m sure had I said that, he might not have made the comment that I was “fine.”
I was angry with him because he wasn’t sensitive to my situation, but I never clarified what exactly my situation was. It was as if I was expecting him to crawl inside my mind and magically know these details I never shared with him. I finally got honest with myself and said, If I don’t say the words, how is he supposed to know what I mean. How can I expect him to treat a problem he doesn’t know exists?
I answered my insight by writing him a long letter describing my trauma, my safety measures, my fear, and my need for his help. Once I was able to communicate the previously jumbled information to him meaningfully, he was able to therapeutically respond.
From this episode I learned several things. First, psychiatrists don’t mind read. Second, if I want him to know something, I have to communicate it to him in a meaningful way. Third, just because I think he’s the one at fault in a conflict, he might actually be responding to something I’m doing. Finally, the written word was a very effective tool for me to communicate difficult experiences to him.
We do a duet with our psychiatrists. If we aren’t singing off the same sheet of music, that’s when conflict is most likely. If we have a disagreement with our psychiatrist, we should start by asking him to clarify his position. Listen respectfully. If we still disagree, we need to tell him why we disagree. It can be intimidating in session to say “I don’t agree with you.” There are alternatives. Writing him a letter is effective. Having your therapist talk to him is another approach.
What doesn’t work well is complaining to people who can’t help that he’s a lousy psychiatrist. The conflict is between us and our psychiatrist, not the person we are complaining to who wasn’t even in the room. If you have a quarrel with your psychiatrist it’s far more productive to go to him, either directly or through a clinical third person who can intervene, rather than go to people who have no power and are not properly informed.
In the tug-of-wars that routinely occur in the office of a psychiatrist communication is the critical tool for resolution.