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Online Therapy is NOT the Same as In-Person Therapy and I Miss My Providers

This image is washed in fog, difficult to see and difficult to grasp.

We all have the same questions and so many more. We are living in an unprecedented and terrifying time, something we haven’t dealt with before. What I’m left with is anger. My hypomania had just decreased to a point where I had insight, thanks to starting the medication, Lithium. A minute later life shut down: moving from in-person sessions to phone sessions with my therapist, then from in-person group therapy at my Intensive Outpatient Program (IOP) to online, to online sessions with my therapist.

I continue to have difficulty focusing as I recover from my hypomania/depression. This can make it difficult to write, as you can imagine, but I am trying. You see, I am sad, scared and tired. I have good times of the day but I also have not so great times. This is normal for the way our world is right now, but, currently, my thoughts center around all of my providers and supports. It’s great to connect online with my IOP people and it’s great to see my therapist via technology, but you know what? – it’s not the same. The novelty has worn off and I feel so sad as if I’m just flying out here alone. I miss these people so much. I count on them when meeting in person, but now, it’s not that I don’t count on them, it’s that it feels too separate. There’s a void between us that I am feeling, in a strong way. This is what has made me cry the past few days. I’m hanging on, holding on to my recovery, but it’s abstract, in some ways. I want my supports, my professional allies and I want to feel it, not remember it or imagine it as it will be in the future. I want to feel it NOW.

I heavily rely on my psychological team and right now, it feels surreal, as if no one is actually there. Intellectually I know they are, but the feeling of them, it’s as if it’s being chipped away and I’m scared by that. I am more vulnerable right now, still in IOP, still getting used to the Lithium, while also living this unbelievable existence in order to be safe and keep my family safe.

I just don’t want to feel alone, flying alone, because, in reality, I am not, not even close. My therapist, psychiatrist, my IOP therapist and psychiatrist are there for me and in touch with each other. I am simply not coping well with the lack of in-person meetings. When I feel alone in treatment, which can come about for many different reasons, I become very scared and sad. I talked to them during my zoom appointments today about this. That’s the only way to help myself, to make sure everyone is on the same page. My therapist told me today to not be afraid of my sadness or tears, that it’s all okay. She said I have to not only cope with the current state of our world but I also have to focus on my recovery from 3 months of extreme difficulty, psychologically. I felt validated and I have to keep reminding myself that this treatment team is there for me. I just hope I can get that feeling back soon and, of course, to meet again in person, once it’s safe enough. I just can’t wait to really feel it again.

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The Hypomania/Depression Roller Coaster with a Twist of Social Distancing

December 19, 2019. December 19, 2019. I could repeat this date over and over, yet it would not change the journey I have been on since that day. On that day, I started taking medication for a medical nerve problem. Within hours, I felt as if I were in a cloud, happy and very free. That feeling continued into the next day and by day 3, I was in a hypomanic state. I had never been hypomanic/manic in my life. I felt, literally, on top of the world: powerful, in control, happy as can be and unable to feel anything else. Even the rapid and numerous thoughts and inability to focus felt as if I had a super power that no one else had. I was grandiose and felt above everyone else. I could function on minimal sleep and also experienced de-personalization where I would see buildings or items on a shelf as “too” real where I could become lost in them and even lose time. This went on for a couple of weeks when my therapist and psychiatrist grew concerned as I also began having auditory and visual hallucinations (I had never experienced these before). My psychiatrist spoke with the doctor who prescribed the medication causing these symptoms and they decided to cut my dose in half. This did not change any of my symptoms, including the psychotic ones. I kept fighting both my therapist and psychiatrist as they thought it was time to taper off of the medication but I felt too good. I had never felt so good in my life. Why would I agree to get off of it?

I finally heard my therapist and tapered off of it at the end of January and within days crashed into a depressive episode. It was agreed upon by my therapist, psychiatrist and myself that an Intensive Outpatient Program (IOP) was warranted for more support as I could no longer work. I began IOP on 2/6/20 and remember sobbing through that first day. It was helpful and provided structure especially since my therapist was on vacation at the time. The surprising thing was that I became hypomanic again (without a medication cause) on 2/22/20, which, again, felt amazing. This only lasted until 2/27/20 when I crashed into a depression that lasted 24 hours. I then woke up on 3/29/20 to feeling on top of the world, grandiose, racing thoughts and powerful. Again, my goal in outpatient therapy and at the IOP was to convince the professionals how great I felt and that all was perfect. This would encompass each session. I was not myself: lying to my therapist hours before, canceling a session saying I didn’t feel well when all I felt was power and control. I had never done anything like this with any therapist before. That turned into a lie to my husband, as well. While my therapist didn’t understand why I felt I needed to lie, my husband was hurt, as we don’t lie to each other. While I felt bad about it and owned up to it, the moment when I decided to cancel that session in the way I did felt amazing. I felt as if I owned and controlled the world.

On 3/5/20, Lithium was added to my medication roster. It took 5 days to move up to the dose that the psychiatrist at the IOP wanted me at. On 3/11/20, I started to feel more even moods and even felt a sense of calm, which lasted until 3/13/20 when I felt low in the morning and flat or empty in the afternoon. But the very next day I woke to feel great, hypomanic, grandiose–all of the typical hypomania symptoms but it felt stronger, more than before. It came out that I had not added Ativan to my morning medication regime, as requested by the IOP psychiatrist as well as my outpatient psychiatrist weeks before. I was afraid it would dull my “happy” feeling. When I told them the truth, my therapist at IOP and my outpatient therapist tried to reach me saying things like, “how can we work together if you keep important pieces of information from me.” During my phone session with my outpatient therapist on 3/17/20, I was very confused about my thoughts. They were grandiose as they had been through this bout of hypomania. Telling my therapist that God gave me this gift of pure happiness resulted in her trying very hard to reel me in. She confronted me and told me that I was in charge of the hypomania, making choices, not like before. Over the next couple of days, I saw it for myself. This last episode of hypomania grabbed me and I grabbed back, held onto it and ran with it. I navigated it.

Luckily, I saw it. I saw it and I sobbed. Was I a terrible person? Lying, manipulating? Who was I? My husband was there for me, even with his pain over my lies about the missed appointment and the Ativan. My therapist was and is there for me, helping me now navigate what happened, piecing out the layers and talking about them.

The thing is, this world-wide pandemic began and reared its ugly head over the past weeks in the US. This past week I have had phone sessions with my outpatient therapist, which was helpful yet difficult to not sit in front of her. My last day of in-person groups at IOP was this past Friday, 3/20/20. I will have a check-in session with my IOP therapist on zoom and then the plan is to move to group therapy on zoom. My discharge date is not set due to my labile mood. Luckily, my therapist and I will transition to having sessions via zoom beginning tomorrow. I am so happy as I truly cannot wait to see her.

This pandemic affects each and every one of us. I am trying to hold on while in this state of psychiatric flux. I am definitely feeling more even and I owe that to the Lithium and my own strength but I do need to continue with the Intensive Outpatient Program and, of course, my 4 sessions per week with my therapist. I need therapeutic support at this strange and very scary time. The past few days have actually, emotionally, hurt due to missing my friends. I miss seeing my therapist. The past 2 nights were filled with sobs, the sadness and fear of so many things hitting me. I worry for society and I worry for those close to me, my husband and my daughter, family and friends. I am simply scared. I do not do well with the unknown during “normal” times, but it is magnified right now. When can I see people, when will the financial markets recover, when will those who are ill recover? It’s too much for me right now. Today I decided I can no longer look at the news, either online or on TV. It’s terrifying. Add on a set of wounded neurotransmitters and it feels…it feels, maddening. I worry for my own recovery, not having access to my treatment providers in a conventional way. I want my in-person therapy sessions and I want my in-person therapy groups at IOP. People do need people…near them, next to them, in front of them. I know I need to be with my people and I need my people to help support me through too many things at once. All I can do is take it one day at a time, otherwise the burden is too much, too heavy. I am still regaining my strength and for the meantime will focus on the treatment I can, luckily, receive.

  • December 19, 2019: the beginning of an unfortunate journey.
  • March 22, 2020: the continuation of the journey in a unique way.

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Risa’s Reality

My mental illness may be treatment resistant, but stigma doesn’t have to be.
RISA


Risa has an MSW from Fordham University and a BA from Columbia University. She has spoken of living with mental illness for the Hartford Foundation for Public Giving and was featured in Women’s Health Magazine’s May 2016 issue regarding mental health. Risa was also a panelist on AOL Build discussing the effects of stigma on those with mental illness. In 2017, Risa was also featured in an episode of Dr. Oz discussing her success with ECT (Electroconvulsive Therapy) and was a featured speaker at Jewish Family Services of Greater Hartford’s first annual event: Embracing Possibility for Mental Health Awareness and was awarded the 2018 Humanitarian Award at the second annual event. She has written for OC87 Recovery Diaries, Huffpost, Psychcentral, Kveller, Keshet, The Mighty, Bring Change 2 Mind and was published in the 2nd and 3rd volumes of Stigma Fighters Anthology. Risa lives in central Connecticut with her husband and their 10 year old daughter.