Psychiatrist wants to discharge me because I can't/ won't engage with therapy

[mydogmymate]

I have suffered with depression my whole adult life ( I'm 54) and I've had every medication under the sun, but nothing has really worked. I've also had numerous talking therapies, but I didn't feel like it has got me anywhere.

I've just been to see the psychiatrist, I see her once every 3 months, and she has told me that, because I won't engage, she will have to discharge me. I can see her point, in that there's nothing more she can do for me, but I can't face another counselling session. I'm fed up of talking about past trauma because nothing changes. I still feel like my life is over, I don't have any motivation to change anything. I just want to sleep.

I'm panicking now about being discharged, I just don't know what I want to happen. I don't have any support, the mental health team can't justify a CPN for me apparently, and I don't really have anyone in real life either.

As anyone else been in this situation? Is there a way forward?

Are you in London?

With therapy you have to go in completely open minded and be 100% honest. If you think taking about the past is pointless it shows you are still suffering from it and need the therapy.

Another thing is - do you actually want to get better? Are you scared of what it will be like as you have not known anything else but depression for so long? Do you accept you have issues? Without all of this you can't and won't get better.

Sorry for the late reply.

Itslikerain - you are absolutely right in what you say, but I've been having talking therapies for over 30 years & I feel no better. I'm on meds too.

The thing is, I've never really jelled with a therapist. I don't really feel like having to recount everything that's happened over the years, after all this time I see no point.

Sorry op. I don't understand (genuinely). Why are you panicking about being discharged if you don't see the point/can't face/can't see the point of another therapy session/30 years of therapy hasn't helped? It's a bit confusing.

Really sorry to hear you are feeling so very very bleak though.

What is it you want? .

The only thing I know about this (which doesn't amount to much frankly) is that depression can be a sign that you are leading the wrong sort of life for you. Is there any chance you could go about tackling some small steps to change it? (If you think that might help of course.)

Thank you for your reply.

To be honest, I don't know what I want. It's easier to live this life than to tackle my problems. I know this is wrong, but I feel beaten down so much by life that I have no will to change anything. I think my panic at being discharged from the psychiatrist is that it is the end of the road & this has been my life for so long that I don't know any different.

Sorry this is a bit garbled, I'm struggling to voice how I feel. I just feel washed up.

Don't apologise mydogmymate. It all sounds very hard indeed.

And life does beat one down at times.

So sorry not to be able to offer any advice or say anything helpful but I do very much hope life becomes easier for you .

Did you mention to your psychiatrist that you feel panic at being discharged btw? I only ask because that does demonstrate engagement at one level.

And don't reply if it's too intrusive, but do you have a dog?

They are a great motivator to get up and out every day.

Last thoughts: probably not very original but anyway ...

Could you contemplate making some very small, manageable, realistic, tiny changes that would improve life for yourself in a minor way?

It's easy to say from behind a keyboard but I get "stuck" sometimes confronting tasks (usually chore related) that I really don't want to do. I find that the way to turn it around is to do 5 mins or so and from that one definitely get more motivation to do the next 5 mins. It definitely doesn't work if I sit and wait for motivation ifyswim. I have to fake the motivation first and from that "true" motivation arrives! I know housework is a very poor example, but just trying to demonstrate that small steps can sometimes work and are not so overwhelming as trying to tackle a whole set of problems all at once.

Sorry - that probably sounds all v self-evident and unintentionally patronising - and v easy to say and not so easy to do probably.

i don't like the nhs, but it seems in this case they're being honest. they're probably genuinely at a loss. if you've had thjis for years, and nothing has helped, then they may genuinely don't know.

you should ask her why she thinks this way. ask her to give you a detailed account, which is her duty really.

I have been sent n similar position but then got pregnant .

He gave me the motivation to put all the therapy into practice . It did once I found my motivation . I also changed my outlook when I started going down what do I need to do to change this situation.

So while it is very scary been discharged it is time to think about what you would really like to do and what steps you can take to get there.

I also reached the point where I had done enough talking about the past . It felt very disconnected to me I had repeated it so many times. That was no longer my problem

Would your psychiatrist consider referral to a psychologist? Change of approach may be what you need. Everyone is different and it may work for you particlarly working on your thought processes.

Ask for a different type of therapy? Mindfulness or CBT if you don't want to talk about the past?

This is exactly why there should be practical alternatives.

Firstly don't beat yourself up. You have tried it but seeing someone for an hour every so often isn't enough and wouldn't be for a lot of people. If you have no other support you have days upon days without any help.

Therapy often looks to the past and I think can be damaging. I know lots of ppl who say it made them worse and they had to stop. Sorry I'm derailing but think practical help like picking you up and taking you to an activity once a week or something would be much better. Loneliness is such a problem.

It's so often that therapy doesn't work so the patient is blamed. Obviously you want to change but feel you can't which is your mental health problem. You are being made to feel guilt which is ridiculous. They should be making you feel more positive. If a depressed person could just change then thst person isn't long term depressed. So I'd say to yourself I'm not going to feel bad about this. I attended appointments but I need to do something in real life. Mabey you could ask them for support moving out therapy as it can institutionalise people. It's crap they just ditch people.

Therapy isn't just about being ready. That's very important, but if therapy hasn't helped you then your psychiatrist is misguided to to ask you to do more. Perhaps she naming this as a reason when it's simply that their team have nothing more to offer you it's wrong to make you feel to blame. Mental health services aren't helpful to everyone. You might need to find something else.

Thank you so much for all your helpful replies, sorry to take so long to reply.

I feel a bit better today, I've come to the conclusion that I need to help myself a bit more, I think I've got myself in a bit of a rut, mental health wise, and as the NHS can only go so far. Now I've thought about it, the threat of discharge was made to make me agree to more therapy and I don't think she was expecting me to reject any further treatment. It's understandable though, there's only so much that can be done.

I waited 2 years to see a psychotherapist, but I found her a bit prickly and not very helpful. I've also had CBT, but I found it difficult to engage with that. I've had the feeling that I was just going for a weekly moan about my life. It was a waste of an appointment.

Because of the lack of resources, I feel like I have to be grateful for any help that's offered. This despite the fact that so far nothing has helped me. I'm certain there are other treatments that I could engage in that don't require intense talking.

Once again, thank you for all your kind replies. It means a lot.

well ok the nhs is bull since it doesn't matter if they have a clue on how society works or not. they all live in an ivory tower and dony get how people relate to others. the nhs is stupid and especially for mental health.

are there are non medical things you do?

Could you afford to pay for therapy yourself? A different type of therapy?

And have you looked at this?

www.amazon.co.uk/Inflamed-Mind-radical-approach-depression/dp/1780723504?tag=mumsnetforum-21

Personally I don't think CBT works for long term depression and the evidence suggests this too.

A bit harsh namitbabe! The NHS helps a lot of people. My partner has suffered with depression for years and while he has had counselling he will not change his lifestyle as suggested. He was told exercise, such as walking , and finding an interest may help plus it would get him.out of the house. I was also told that some people with depression actually don't want to get better ! Not sure if that's true . Hope you find what is right for you OP.

I don't want to slag the NHS off, it's been a life saver in the past. I just object to the one size fits all method of treatment.

I have paid privately in the past for counselling, but I'm not in a position to do that now. I was told by the psychiatrist yesterday to go to a gym and join slimming world ( my cholesterol is high) but, although she's right, I found that a bit patronising. I'm not very overweight and I have a dog that I walk everyday, so my lifestyle isn't that sedentary. I know all the evidence is out there that diet and exercise do help, but when I struggle to even clean my teeth some days, that suggestion was a bit like using sticking plaster to cover a hysterectomy wound iyswim

I've been seeing this psychiatrist for 5 years every 3 months, now I feel she doesn't know me at all

I had the option to have therapy or not. Either way I can continue with my psychiatric care.

@namitababe are you a specialist? I just wonder why you are so vehement?

no, i'm a former patient. i mean all that i say.

Don't feed the troll...
Thing is its easy for me to say this but I can see you can end up being comfortable with misery - is this something that clicks? I second making one small change every day and sticking with it - do so for three weeks say and it will become a habit.
Also how are you when it comes to getting out into nature - that is what kept my sanity this time last year when facing redundancy, rejections and 0 job offers.