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What do I do when my therapist gives me an ultimatum?

By August 19, 2010 - 9:24am
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Been in therapy for 10 months. Depression symptoms have been up and down but a lot of other stuff going on too -- marriage issues, business failing, chronic health problems (breast cancer) -- that make it worse at times. I have considered suicide frequently as a way out, my therapist knows this, I hide nothing from her. Now she is refusing to work with me unless I agree to take antidepressants which I've avoided all this time because I just don't feel right about taking medications of any kind, let alone antidepressants. I'm not sure how I feel about being given an ultimatum: am I feeling rejection? Abandonment? Worthless and awful because my own therapist won't work with me unless I'm medicated?? Not sure what to do or how to think about this......

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The ultimatum came because i've been depressed and suicidal for several months and "doing the same things expecting different results" is getting us nowhere. she's right, i know she is...but i'm so scared of taking antidepressants and what they'll do to me mentally. i have been treating my cancer naturally, with no medications........but the suicidal thoughts are so powerful i'm beginning to think there is no way out of this without meds. i don't use tylenol or motrin, etc either.....she is telling me i need medication in order to see further progress b/c talk therapy is no longer effective, in her opinion. she did say i am suffering needlessly and need further help. if i continue to refuse medication, she recommended another counselor but i don't want to talk to anyone else, it's too horrible to think about starting over.
the fear is so great that it's easier to do nothing and succumb to the suicide, which sounds like relief and peace and nothing......we have tried everything else, she has been very patient because she knows i don't want antidepressants.....i really don't know what to do and i really don't care most of the time, i want to die so much most days that it consumes me. i even called the suicide hotline but chickened out when the person came on the phone......what a loser.....

August 21, 2010 - 5:30pm
(reply to ewriter)

You can call the suicide hotline as MANY times as you need to.
You can dial, hang up, dial again and speak to someone as often as you need to.

It is, of course, scary to talk with someone you don't know about such an intimate topic. That is OK, and is normal. That is their job, and they are good at it. Give them a try!

There are no judgments or name-calling that you need to do to yourself. Seeking treatment is hard, and you are making these healthy decisions for yourself. It is a daily decision to decide to BE HEALTHY and KEEP MOVING FORWARD...and you are doing a good job EVERY DAY you make that decision.

You sound very proud of the fact that you are treating your breast cancer "naturally". Can you describe what "naturally" is, and tell us what treatments you are choosing to use? Are you seeing an oncologist or other specialist? Have you found the treatments successful?

You sound like you want relief and peace. There are many ways to find relief and peace, and you are right---none of them are perfect, but they are choices and opportunities that you have:

1. You have a counselor you like, and she feels you would improve with antidepressant drugs. You are scared to take medication, as "what will they do to you mentally". How are you doing mentally right now? Have you thought of the other possibility...what if the drugs DO actually work, and improve your mentality and emotional health?
2. You have a referral to another counselor who would be OK continuing talk therapy without antidepressant drugs. You are scared to start over with another counselor. Have you thought that you might even like this counselor BETTER? What if this new counselor is able to provide new insights and perspective that can help you improve without medication?

Bottom line: do you agree with your counselor that you are "suffering needlessly?". If so, please know that you do have many options. You have many opportunities. None of these decisions are permanent; you can decide to stop taking medication. You can decide which therapist works best for you. One path may lead to another path, but you need to take the first step.

- Have you talked with other people who have taken antidepressants? - Are your fears based on reality of these medications?
- Would you like some resources about the pros/cons of antidepressants?
- Would you like to talk with other women who have taken antidepressants, and it worked for them and they did not feel like it messed them up mentally?

- Do you have a support system of friends and family?
- Do you have a support system with other women who are living with breast cancer?

I look forward to hearing from you!

August 21, 2010 - 11:11pm

Can you tell us more about WHY your therapist gave you the "ultimatum"? Perhaps talking about it more in-depth (besides just putting a term to her words) could help. For instance, has she been telling you that you may need antidepressants to see further progress? Has she said that "talk therapy" is no longer effective, or that she can not do anything more for you? Does she feel so strongly that antidepressants could help you, that is is painful for her to see you continue to struggle? Can she recommend you to another therapist if you decide not to use antidepressants?

A few other thoughts:
Have you explored the pros/cons of antidepressants (I am sure you have, but perhaps writing about it could help, too). Have you talked with your therapist about your concerns, and what was her response?

I am always interested to learn more about why people take strong stands 100% for, or 100% against, something. There are few behaviors or choices in life that can be labeled as "always" or "never". Are you willing to explore these feeling with us? You said you do not "feel right" about taking "any medications of any kind". Why? Is this including over-the-counter medications (Tylenol, for example), or only prescription? Is it only medications that have a bad societal context (unfortunately, that could be antidepressants), but what about medications for cancer treatment? Or just gas relief? What if a person tried all of the natural and herbal remedies, but still can not find treatment without medication.

Are medications "bad" if they are helpful?

Lastly, is there a "happy medium" between you and your therapist? Are you able to try a mild dose of antidepressants for a short time, to see if they help? Are you able to try some other forms of therapy that does not involve medications, that could be recommended by your therapist?

I hope to hear back from you!

August 19, 2010 - 2:42pm

Hi ewriter,
Thank you for your post, and for finding EmpowHER. I'm not a doctor, and I can't diagnose, or tell you what to do. All I can do is share my experience with depression (http://www.empowher.com/user/2186/dashboard/history?page=28), refer you to some resources that may be helpful, and give advice on next steps.
Here is a group on EmpowHER about depression. You may want to sign up, and share your story:
Here are suicide resources:
National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org (800) 273-8255 (TALK), or (888) 628-9454 (en Espanol)
Crisis counseling: (800) 999-9999
or Google: International Suicide Helpline Numbers
Contact any and all of them for assistance. Contact emergency services (911 in the USA) in a low point if you feel you may do harm to yourself. I hope you can thank yourself later for being so on top of this.
Here is a link to the EmpowHER Groups page. There are two breast cancer groups there. Share your story, and start actively moving forward. You may see a difference in other aspects of your life:
Also, you may want to check out the Depression and Breast Cancer pages:
Please keep in touch with us at EmpowHER. We are here to inspire and support each other. We want you to be able to get a handle on your depression so you can have as good a life as you can. It may take some doing, but please don't give up! Those better days may be right around the corner.
Good luck and let us know how you're doing and how else we may be able to help you.

August 19, 2010 - 11:01am
(reply to Christine Jeffries)

Thank you for the resources and encouragement. Muchly appreciated.

August 21, 2010 - 5:31pm
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