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Case Conference - Not Again :'(

razza

razza

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Well as if I didn't have enough to deal with...
I found out on Friday that this coming Wednesday I have another case conference...
The last one back in late Oct/early Nov (forget when) went... horribly :cry:

My biggest fear when I went to that one was that I would be dictated to and POWERLESS. I expressed this fear clearly to my group therapists... They promised it wouldn't be like that... But

It went exactly as feared. I had NO voice in that room...
I felt powerless, dictated to, unsupported.
It caused a lot lot of PAIN.

I had been dumped the week beforehand by my psychologist I had been seeing for nearly 2 years so I was feeling very fragile so after this I broke apart...

To add insult to injury a few weeks later I received a supposed recap of what we discussed which caused a great deal more more pain...
The main pain was related to them adding a BPD label in that letter. I have never identified with that label, I have conceded that some of my symptoms of depression may fall within some of the traits. But my depression came long before they developed.

For example claims of dependency and intense relationships - before I became depressed I was quite content with being with people or with being on my own for extended periods, I didnt mind either way. I wasn't dependent on anyone... It was only after I began "treatment" and was asked to trust and open up to my treating team that I started to rely on their support. Intense ideation or devaluation of people? Even when someone has done something to upset me, I turn it towards myself and what I have done "wrong", I dont Love or Hate people, there are shades of grey to everyone - except myself. My posts here show this all the time, its always me, my fault...
SH urges only appeared 10months after first diagnosis and only after a switch to Prozac which made me feel like my skin was crawling, I scratched too much at those itchings... Suicidal thoughts only developed for the first time in October this year, over a year and a half from first diagnosis of depression, and only after stopping Lithium and being placed on moclobemide which I told my pdoc I felt I was having adverse reactions to (including I felt my thoughts were sliding along the spectrum closer towards suicidal thoughts) but she chose to keep me on it. Both the SH and suicidal thoughts developed after external triggers, "traumas" maybe the word :unsure:...

I do not identify with it and when I tried to express my fears about it, valid fears too about not identifying with it, stigma (I have experienced it from medical and MH professionals, including my treating team - although didnt say that to them :p) and also that I felt my depression was always being pushed to the side...

Well my therapists turned it back on me and claimed I had misheard them in that room. I did Not. I am so sensitive to this issue that no matter how scared I was I would have said Something if I thought for one second they wanted to label me with it as I don't identify with it and so didn't want that on my records, I had experienced enough stigma already when people merely found out I was doing a group based on DBT which was developed primarily for people with BPD, even though I was told by my treating team when I started it that I did not fit the criteria and I was doing the program to help my depression...

I still feel my depression is not being given the attention it needs because everyone is focused on a PD I don't believe I have, how I am now, this so called "personality" was not one I had prior to being diagnosed... It wasnt even present when first diagnosed with depression and anxiety, and I still had never heard of it 6months after diagnosis...I even recall in Feb 2011 they told my group that none of us met the criteria for BPD...

I think the thing that keeps me stuck is the depression and primarily my thoughts and negative thinking patterns yet none of my treating team has helped me with this at all...



Sorry for the long rant...
I am just so anxious and worried about this case conference.
I told my group therapists that I would call them Monday or Tuesday to discuss skills and the conference (I dont even know who is attending, if my pdoc will be there or the manager of the MH services - so scared if he is because he was the one dictating last time who left me feeling the most powerless).

I already feel so fragile

I don't know what to say to them when I call and definitely not at the case conference...

What if it goes the same as last time?
What if this breaks me??
:cry::cry::cry:
 
S

sam_dmsu

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Hi razza I wish I could give a hug to help what you're going through

I think they're being unfair and helping you with such a bad approach. They shouldn't put you in the centre and crowd you with other therapists and they should start of questions that are comfortable for you and allow you time to talk. If I was there, I would feel exactly how you would feel. I would want a 1:1 in a doctors type room and wait for me to be ready to talk.

Can you change to a different therapist or talk to your doctor for advice?
 
razza

razza

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Thanks sam :hug:

My doctor is... quite horrible really. I find him very unempathetic, unsympathetic and very arrogant and patronising when he talks to me. I tried but it isn't working and I am thinking of finding another doctor as I feel very unsupported by him...

My psychiatrist, I don't know if she will be there. I have mixed feelings about her, but my last appointments with her I also didn't feel that supported, it felt like she was giving up on helping me as none of the antidepressants we have tried have had any noticeable effect. I also felt like she was a bit annoyed and frustrated with me. My anxieties and fears stop me trying to find another psychiatrist, and as it is a relatively regional and small town area, there are not that many available - most of the ones in this area work with my psychiatrist and are therefore not an option.

My group therapists are the only ones in the area who run this type of group as a private health insurance group. I do not want to go into the public system if I can help it. I like them, especially one of them who I saw individually when I was in her hospital (they are both psychologists at the local private hospital's mental health unit). But it upsets me that they cannot see how much damage they can do... It upsets me that MH professionals I've had contact with won't admit that maybe they got their approach wrong, that they could have done things differently.

I am on the waitlist to see a private psychologist for individual therapy. I don't know how long it will take though. They said 6 weeks initially, I think it's been 2, I'm not sure. I don't know if it will work out....

I feel trapped, I have to go to this meeting, it's expected and I expect that like last time, they would tell me that they are having it whether I am there or not and that is just as scary an idea.
But I don't want to be in that room on Wednesday. I just want to run away and hide...
What if it is just like the last time.... Or worse?
 
S

sam_dmsu

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Yeah try and change your doctor if you feel he's not helping at all. I had a doctor in the past who was rude and not at all friendly. I changed to a different practice, but last time I heard some patients made a complaint and now the doctor has changed his attitude. The doctor I have now is friendly, understanding and it's no wonder she's always getting fully booked or the patients just want to see her and not the others. I do hope there's another available doctor in your area who will be more understanding, helpful and patient than the one you're having now.

I think it's the situation that your in a group and you have 2 of them and just you by yourself. You like it when you meet them individually, but when they come together it's like they are 'ganging up' on you.

If they asked you the questions like they did in the previous group meetings but in a room with just you and one of them, would it make you feel better and let you feel comfortable to discuss what they need? Maybe say that you can progress better for both you and the medical team as you can be more forecoming if you discussed it 1:1

It would be nice to have a supportive person you can rely on to go with you in these group meeting. I'm sure one of us in these forums would go with you, give you lots of hugs and say "it's alright, they are there to help, we're here to support you, take your time"

If it helps, write down what you want to say. I do when I go to meetings, it helps me focus somewhere else and get my point across what I cant remember.
 
-Phoenix-

-Phoenix-

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This is good advice Sam. I wish one of us could go in with you, but being stuck on the other side of the world kind of rules me out. :(

Take someone with you if you can. If you are facing a group of them, then you should try and even the odds a bit.

But is there anyone you'd feel comfortable taking with you at the moment? To be honest, I'm not entirely sure what a case conference is but it sounds as scary as a job interview. :scared:

And I'm not sure if the same rules apply or if this is helpful at all, but when I was a trade union rep in these kind of formal meetings we could always call for an adjournment (or "timeout" as we liked to call it) if it looked like someone was struggling and needed a few minutes to catch their breath. If you start to feel like it's getting difficult to speak, don't be afraid to ask to postpone the case conference for a few minutes to recuperate.
 
pepecat

pepecat

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It'd be good if you could take those last two paragraphs from your first post in to the case conference. The ones starting 'I still feel.....'
They get your point across well.
Could you ask that there aren't so many people in the room? I mean, do they need BOTH your therapists from group in there, for example? Surely they could agree on what they want to say and then only one of them go in. I'd hate it if there were loads of people - it'd been like a job interview... and i'm crapper than crap at them!

I guess the thing to do is try and stay calm, and listen carefully so they can't accuse you of misunderstanding them or reading things in to what they're saying because you're panicking or (in their eyes) over reacting. It's tough to do, but if you can, it'll probably help.
 
razza

razza

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Thankyou sam, MB and pepecat :flowers:

Sorry, I should have explained what a case conference was... It's to discuss my treatment program, how it has been up to now, what direction it should take in the future.

My two therapists were both there last time - I don't know why they both need to be there since they consider themselves "equal", maybe they think it will save time catching up later... If I asked for just one it would probably end up being the intern and not my preferred therapist so I'd rather they both be there if it meant she was there as well.

Last time it was me, my pdoc, my therapist and the manager all sitting in the hospital's group therapy room - the tables had been pushed together to make one really large table which we sat around with me on one side and the others around the other edges. I was told it would be a discussion but it didn't feel like that. The manager seemed to have a lot on his agenda, I think he even surprised the therapists perhaps because they didn't allow enough time for me to speak. They only asked me 2-3 times what I actually thought, the rest of the time I felt completely overwhelmed and bombarded with what I can only describe as a dictatorship... I felt I was completely misunderstood and misinterpreted... I got really upset at one point, crying :cry: and they made me do a short mindfulness exercise but they still didn't recognise that it was too much...

I think they completely miscalculated how much the meeting and subsequent letter would affect me - it is not the first time they have done so, and they know me pretty well so to so completely do the opposite of what they should know to work for me, I thought they understood me better than that, they have understood me better than that so why could they not see their approach was not helpful for me at all until the damage had been done (and they still wont admit they might have gotten it wrong)... Why did they take away all my power when I said I was scared about being powerless from the beginning and they promised it wouldn't be like that??

I rang and spoke to the intern, therapist C today about the meeting. She wanted to focus on "skills" to help me before, during, after and not really on all this stuff surrounding it. I did manage to tell her how powerless I felt last time and how it made me feel a lot worse, it affected my trust, it made me feel my thoughts and feelings weren't important and I didn't want it to be like it this time. She said they didn't want it to be like that either so perhaps a small acknowledgment of sorts? I also told her that I didn't feel like I had enough chances to speak - my anxiety and the fact I struggle between knowing when someone has finished talking or is just drawing breath, makes it extremely difficult for me to risk potentially interrupting in order to have my say. So maybe they could check in with me more?

We discussed being able to have short up to 1min, 2min max, breaks to just stop and focus on calming my breathing etc if my emotions hit me, as they have seemed to do only in "safe" environments (strange or not so strange but even though am terrified I always cry much more easily during group, pdoc appointments, whenever I am in the hospital or talking to my helpline counsellor Leila). She said "bearing in mind if we have a 2 minute break we can only have two of them because we won't get through everything as bearing in mind we only have an hour"... :scared:... I said I don't know if I will need 2minutes or if less time will do because I can't predict that.... But if she thinks we can only spend 4mins out of 60?? :scared: I said I would rather we take 2minutes to slow things down before my emotions got too much than me get really upset and spend 4minutes or more in that state because that is not helpful, I won't be able to take anything in or feel very supported if I am too upset...

We will see.

Also when discussing skills she suggested I take in water to drink and a stress ball to "ground" me. Eat some breakfast beforehand. Do distraction and self care before and after. Make two music playlists for the car - a CD of loud music to release any distressed emotions afterwards then a calmer one to bring me down. Go shopping or to the movies by myself after - argh even the "skills" are overwhelming me :cry:

She suggested I write down what I wanted to say to using the "dear man" interpersonal skills we do in group. The problem is, I said, I don't know what is to be discussed so largely I will be trying to respond to the topics they raise. I said there was only one thing I could think of that i wanted to discuss but I don't think they will be able to help me with it - thoughts. She said that was something perhaps best suited to discussing with an individual therapist when I get one :cry:, so I don't hold out much hope that me raising the 'depression has been forgotten' issue will achieve much :(

Especially as my pdoc who is perhaps in the best place atm to help me with that, well she was supposed to be there but she is away, some kind of family emergency in her home country India. The manager isnt going to be there either - the deputy manager is :eek:. He is not as intimidating as the manager, much more approachable. Except the last time I had contact with him was on the phone back in July when I was really upset and he was very short and quite rude. I don't know if I caught him at a bad time but he wasn't how I had come to know him after two admissions so I'm scared. Hoping my therapists do most of the talking to be honest!

Guess now all I can do is wait and freak out! :cry:
 
S

sam_dmsu

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The way you described the case meeting I would behave the same in that situation too. It's awful they put you in that situation and a really bad approach in helping you. So it's not your fault.

I think you can take to this next meeting positively that it has few people and a different person who is more approachable. Is the next meeting talking about skills? If so, maybe before the meeting just prepare and write on paper ideas or things that come to mind about skills. It would probably help when voicing about it when you see it on paper to recite from. At least you got it there in front of you to fall back on.

I had a meeting today with someone who is more approachable than the other person I usually meet and it was so much better to talk and I felt more relaxed. I hope it's the same for you in your next meeting.

So know that you're not alone on how you feel in the situation you are to be in. Know you got people here you can talk to and understand and relate what you're going through :)
 
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-Phoenix-

-Phoenix-

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Thanks for explaining. I think I have a better understanding now. But then I got curious about what "dear man" was all about. Initially I pictured you going into the conference room and saying "Hello, dear man!" to the guy in charge or something... :unsure:

Not to worry, I googled it. I know roughly what it's about now. No need to explain. :)
 
razza

razza

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Well the conference is in less than 12 hours. I am trying not to, but just between you and me...

I'm PANICKING!!!!!!!!!!!!!!!!!!!!!!

:cry: :cry: :cry:
 
M

mckie

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Case conference not again.

I hope it hellps to write on this forum. You can always send a private message if you wish to whoever thinks is most helpful. Take care
 
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S

sam_dmsu

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Try and relax your breathing, slow deep breaths and keep your mind focusing you enjoy, make you laugh, happy. I watch on youtube Susan Boyle's 1st performance and it makes me smile and relax.
 
-Phoenix-

-Phoenix-

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If they are discussing a treatment plan with you then I would have thought the psychiatrist would be there. Shouldn't they all be consulting with each other? :confused:

Kick their asses razza! Well, I don't mean *really* kick their asses. That wouldn't be good. But you know what I mean! :redface:

Whatever happens, I'm thinking of you. :hug: xxx
 
razza

razza

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Well it's over with, sorted...Kinda.
At same time...
Feels like everything is over :cry:

Sorry :(. I can't get my head around it enough just now to explain what happened...
Struggling again :cry: :cry:
 
S

sam_dmsu

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Although it was very difficult for you to attend, you did attend and you went through it. That took a lot of courage and will power. I think I speak for the others that we're so proud of you!

So big big :hug:

When you're ready to talk about it then we're always here to listen to you :)
 
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