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PostPosted: Tue Apr 18, 2017 9:32 pm 
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This isn't so much about Suboxone as it is about treatment approaches to life problems, trauma, personal development. I was hoping to hear from people who've seen both psychologists and psychiatrists, and to get their take on what worked for them long term.

Reason I ask is I find myself in a juncture at the moment where both my psychiatrist and myself have been medicating the symptoms of my issues for all of my adult life, but it doesn't seem I've gotten anywhere. Recently I was taken off lithium and have been relatively unmedicated for a week or two as we prepare to find another mood stabiliser. And during that time a lot of unresolved issues have surfaced which I feel I really need to work through with someone to guide me through the process, whether a counsellor or a psychologist. My psychiatrist doesn't delve into my past at all. It's all CBT, what are you doing now, how can I change the way I approach situations. But the mainstay of his treatment is medication. I know if I end up on a load of medications again, I'll be suppressing these memories and not end up working through them.

This relates to Suboxone too because I do see Suboxone as another medication that suppresses and blunts these memories and emotions. As do all opioids, benzos, alcohol, nicotine, SSRI's, anti-psychotics and mood stabilisers. Drugs in general really. Each in their own way and each to varying degrees.

So who's done a lot of psychology and counselling in their time and how has it worked out? Could you survive on less medications, less or even no Suboxone, as a result of working through your past?


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PostPosted: Wed Apr 19, 2017 11:44 am 
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Hi TeeJay, I am going to try to answer this question from both perspectives...as someone who has been in therapy and as someone who does therapy. You can not begin to address issues from the past if you are depressed, or experiencing symptoms of mental illness that will get in the way of you working through these issues. Medication and talk therapy can work hand in hand to support someone in moving forward and living a good life. Did I answer the question? I think there is a time and place for both. I hope this helps!


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PostPosted: Wed Apr 19, 2017 12:06 pm 
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Hey Teejay,

Excellent question in my opinion , First I agree with Michelle about getting stabilized before digging deep.
That stuff's work, and you have to be in good shape for it. It's painful to talk about the past, to admit and truly own one's mistake while finding a way to make peace with yourself..And peace with one's family members... who usually have problems of their own and have likely contributed to current unhappiness.

There are two basic models at work...the medical and what's called the psychodynamic. These days psychiatrist tend to be focused on medication and medication management, In the old days they would usually do therapy as well...

Both approaches are valid, but each has its limitations. A lot of his stuff really has to do with imbalances in the brain, so medication is really needed. But as you point out, it can only take you so far.

I admire and respect your fighting spirit, and your desire to improve as a person That comes through loud and clear.


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PostPosted: Wed Apr 19, 2017 8:52 pm 
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Hi Teejay,
I understand your situation with medication, especially feeling as if your thoughts/ feelings are blunted. I am diagnosed with Bipolar II, which is not the same as Bipolar I, but nevertheless has a strong organic component and wreaks havoc with one's life. I have been on antidepressants, mood stabilizers, and benzos in various combinations since I was 18, for around 20 years. I have also self medicated with alcohol, marijuana, and cigarettes, and finally opiates. We classify the drugs according to their most beneficial uses (like anti-depressant) but they are all powerful psychoactive drugs with side effects. We try to make sure that the benefits of taking the medication outweighs the risks, but it doesn't always make us feel better about the side effects.

I have been medicated for so long that I sometimes am not sure what parts of my personality are just mine, and what parts are due to various effects of all the medications I take. I have gone through the questioning, the cycles of quitting medications to experiment with "real" life, trying to be my own doctor, deciding that Vicodin worked better as an antidepressant than Zoloft, and trying to manage my medication as if I was a psychopharmacologist (I am not). These experiments have always ended in the same way-falling into deep depressions, having horrible mood swings, and begging my psychiatrist for help. I hate, hate, that I have to have medication, but it is just a fact I am learning I have to accept.

When you have an unpredictable, cycling, and destructive illness such as Bipolar Disorder, sometimes our normal, regular brain chemistry, are even more distorted off medication than while on it. Thoughts, feelings, perceptions and "truths" that we may have while off medication may be less real than our perceptions on medications. Like addicition, mental illness tends to trick the mind into believing things that may not be true. This is my long winded way of saying that even with blunted emotions, we need to take medications that help keep us healthy and productive.

That being said, evidence consistently shows that medication plus psychotherapy offer the most benefit for the patient (as Michelle said, much more succinctly) I have been in and out of therapy for 20 years (not consistently) also, but fairly consistently for the past 10 years. I go more when I'm stressed or struggling with symptoms, and less when things are going well. I sometimes take breaks for a few months. In addition I provide psychotherapy to others (I have a degree in counseling psychology), so like Michelle, I have experience on both sides. You can absolutely can work through issues from your past while on medication, and if you have trouble remembering while on medication, write down how you feel now, and talk about it once you are on your medication.

You should think about what your goals are for psychotherapy, and specifically for working through issues from your past. People often think that they must "work through" the past before they can move forward, and this is not necessarily true. If you have severe trauma, you will want to make sure that you are ready to delve into that, and to find out what you want to gain. Do you want improved relationships? to be more productive, or successful? just to have someone to listen to you who won't judge? to stop having panic attacks, etc. Trauma often needs to be worked through, and by looking at the past, or how we were raised, or experienced childhood and family life, you can begin to discover patterns of thoughts, behaviors, and perceptions that you have most likely continued to repeat-leading to often the same results. You want to make sure that if you have severe trauma in your past that you have an experienced therapist (in my opinion a psychologist specializing in trauma) to help you through painful feelings. An inexperienced therapist may be overwhelmed by trauma and respond in ways that are not helpful and sometimes more painful for you.

Some psychiatrists still do psychotherapy, but often times a psychiatrist handles medication management and a therapist does the therapy. If you do it that way, it is important to make sure the two communicate to help you the most. There are many types of therapy. CBT, ACT (acceptance and commitment therapy), and DBT (dialectical behavioral therapy) are the most popular right now and are considered "evidence based" because success can be more easily measured than in psychoanalysis or supportive talk therapy. The SMART recovery system is largely based on those three types of therapies. There is also psychodynamic-incorporating various techniques, but it targets all areas of life rather than specifically "behavior".

All of this is great, but evidence has also shown that the most important predictor of success in therapy is having a good relationship with the therapist. The therapeutic relationship-one in which someone listens to and experiences every aspect of your thoughts, emotions and behaviors, and does not judge you is what helps people heal and move forward with their lives. Knowing that no matter what you do, or think, or feel, you are still valued, is the most amazing feeling, and it is not something that can be reproduced outside of therapy. Friends, family, co-workers, classmates, etc-they all have complex relationships with you, making it almost impossible to be completely non-judgmental. That is your therapists' only job-so they get good at it. After you have experienced a successful therapeutic relationship you can carry that with you to your other relationships.

I had several therapists in my twenties, who used various techniques, which were somewhat helpful. But not until my current therapist, who I have been seeing on and off for 10 years have I felt the full benefit of therapy. That is because I have a relationship with her and she has provided a safe place for me to confide, to grow, and to change. And the boundaries are helpful too. I only see her at therapy, we talk about my life (I know a little about her too, but the focus is on me), she expects nothing from me, etc.

So, yes, Teejay, please go get therapy. Find someone you can relate to, make sure they are qualified, and make sure you know what your goals are. Find a medication to keep you stable. You know that your brain chemistry requires that. Your doctor can hopefully help you find that. Have you been on Lamictal? That has been the most helpful mood stabilizer for me, and works as an anti-depressant too. Sorry so long, just had trouble stopping once I got started. Good luck!

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PostPosted: Thu Apr 20, 2017 6:43 pm 
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Thanks all taking your time to reply.

I see the benefit of being stable before taking on therapy. It's a double edged sword as well, given I don't really care so much about the damaging incidents when I'm on multiple mood-stabisers. I'm 33 now and I do feel I could have explored things sooner if I wasn't so medicated. I've had to take 6 months off uni recently because of depression, so I'd rather use this time to explore and come to acceptance around these issues, than waste it just doing work.

The guy I'm speaking to is an AOD (alcohol & other drugs counsellor), not a psychologist which I can't really afford at this point in my life. All AOD counsellors are publicly funded in my country, and given 70-80% of "addicts" identify as having trauma, they are generally trained in dealing with trauma. I feel like I'm going to finally be able to tell someone the stuff I've left off my fourth steps. There's some heavy stuff in there that in the past I felt I couldn't tell sponsors given how enmeshed sponsors can be in my NA social groups.

Thanks Tragicom too for taking that time to engage. My main goal I hope to get out of therapy is to reach a level of acceptance about the past and myself, and to explore my self-identity based on things that happened growing up. I just want to be a bit more at peace about myself and who I am. My doctor is actually thinking of putting me back on Lamictal. It will likely happen next week.


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PostPosted: Thu Apr 20, 2017 8:54 pm 
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Sounds like a good plan, Teejay. I think you are right, that drug and alcohol counselors are very familiar with trauma. I'm sure lots of them have "seen it all". Glad to hear that you are working with your doctor and open to continuing medication. I think you will find therapy helpful. However, if you don't, don't give up. When you find the right fit (therapist) it can really help. Good Luck. Hope to read updates!

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PostPosted: Thu Apr 20, 2017 9:34 pm 
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I see nothing in the posts above that I would disagree with.

I am a psychiatrist, but my practice is not typical (my practice web site is at http://www.fdlpsych.com and I have yet another blog at http://www.patienttimes.com. Psychiatry practices are shaped by whether they take insurance. If they do, they tend to have higher patient volumes. Medicaid pays $40 for a med check visit, and insurers often pay less than $100, so those docs schedule 4-6 patients per hour. I've done that type of work, and I hate it. I see it as a reason for lousy care; patients end up on way too many meds, because it takes 3 times longer to explain why you won't prescribe benzos than to just prescribe benzos.

It takes TIME to dianose bipolar disorder. I spend much more time 'undiagnosing' than diagnosing bipolar. Bipolar is NOT being 'up and down' all day. Bipolar is having several mood changes per YEAR. Even rapid cycling bipolar-- where people have more swings and mood episodes-- you need to have more than 3 swings per YEAR. Mania requires all of the necessary symptoms, continously, for at least a week-- and usually much longer. But so many people go in and say 'I have mood swings', and get put on a mood stabilizer!

I fashioned my practice on one I used to go to in Milwaukee. I do not take medicaid or insurance. The first visit is 90 minutes, and subsequent appointments go from 30-60 minutes- never shorter than 30 minutes. I agree with the comment that connection with the therapist-- the 'therapeutic alliance'--is very important.

Psychiatrists prescribe medications. That's the main issue between them and psychologists or therapists. Some psychiatric residencies are mostly 'biological', like the program at the University of Wisconsin in Madison. Othere emphasize more therapy. My prowm was at the Medical college in Milwaukee, where we had a connection with WI Psychoanalytic society, and so residents from that program are more comfortable providing psychotherapy.

About theray... there is a spectrum that is used for patients, ideally depending on patient needs. The two ends are called 'supportive' on one side and 'expressive' on the other.' Supportive therapy is used during crises, with the intent to support the ego (the 'self'). At it's simplest, a therapist takes in what the patient says, and clarifies, repeats, or rephrases it. if the ego was a billiard ball with a chip on it, supportive therapy would fill in that chip with some plaster and buff it until it is smooth.

The expressive end has psychoanalysis at the extreme end, where the patient lays on the couch 3-4 days per week, and free-associates while the analyst sits out-of-site, behind the patient. Somewhere a bit further in on the spectrum would be psychodymanic therapy, and in the middle would be CBT, or cognitive behavioral therapy.

Analysis and psychodynamic therapies are also called 'insight oriented therapy', and also called 'anxiety provoking therapy.' The goal is to help the patient let go of assumptions, and to see the world differently, in may different ways. The patient may have always thought he/she had great parents who did a perfect job. But they may learn that in reality, there were many problems. Maybe they had a 'double bind' situation growing up, where if they were too successful they would make someone esle feel bad... but at the same time, if they were not successful enough, they were taught that they had no value.

Maybe mom or dad was controlling... not on purpose, but just through a million small actions... and now. Now that the child is 'free', he/she is depressed, because he fears that life is nothing but chaos.

Supportive therapy usually finds something to work on, and focuses on that for 12 weeks. Expressive therapy can go on forever. Analysis is a special type of theray where a person is seen more often, evern 4 days per week.

One common mistake-- people often think that the more messed up a person is, the more theray the person needs. In reality it's the opposite. People having a lot of therapy can really fall apart, and the therapy has to be decreased until they settle down again. Frequent therapy can confuse a persion, and analysis is ONLY done if the patient is 'stable'.

If we go to the cue ball with a chip again, expressive therapy would take a chisel and chip away all the area around that chip, and then rebuild it with whatever cue balls are made from!!

One FINAL comment.... there is a narrative out there the people use BECAUSE of something. Some people see it that way. I don't, though.....because if you really look at people in depth, with an open mind, you find that EVERYONE has reasons to use. We all had traumas, some worse than others, but they are always there. Yet some people had very severe traumas, or very crappy parents, but did NOT get addicted to anything. Also, the idea that we all need to work on our underlying issues, and then we can maintain sobriety, is a cool nararrative... but it just doesn't that way in reality. People with very bad trauma and addictions will work on the trauma... but the addiction stays exactly the same, or becomes even worse.


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PostPosted: Fri Apr 21, 2017 2:16 am 
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Thanks for that Dr. J. A sombre note to end on!

I'm of the classical manic-depressive bipolar type. I was diagnosed first with schizoaffective in my late teens, but over 3 years my doctor adjusted it to bipolar. There were periods of religious delusions. I got baptised at a protestant church in my late teens during one of my manias, because I thought my schizophrenic friend was Jesus and we were going to take over the world. I was floridly manic a few times in my early 20's. And my cycling happens over months, and I usually bottom out around autumn. Sadly I haven't had a mania for some time. Not for a few years.

Do you think that medication can act as a therapeutic buffer? ie I don't really seem to think about my past, or see myself as a victim of my past, when I'm well medicated. It induces a pharmaceutical apathy, and if I see a therapist while I'm dosed up on mood stabilisers and anti-depressants, I just don't have as much to "talk" about. I guess the question for me is about effectiveness. Can talk therapy of any kind help a person get by on less medication? If that were the case I'd rather take that route.


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PostPosted: Fri Apr 21, 2017 4:14 pm 
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suboxdoc wrote:
It takes TIME to dianose bipolar disorder. I spend much more time 'undiagnosing' than diagnosing bipolar. Bipolar is NOT being 'up and down' all day. Bipolar is having several mood changes per YEAR. Even rapid cycling bipolar-- where people have more swings and mood episodes-- you need to have more than 3 swings per YEAR. Mania requires all of the necessary symptoms, continously, for at least a week-- and usually much longer. But so many people go in and say 'I have mood swings', and get put on a mood stabilizer!.


Hi- just a note about this. I think at some point it became kind of trendy to diagnose Bipolar, and it maybe there are a lot of people diagnosed who don't really fit the criteria. Then they are put on mood stabilizers, which don't help, and feel crappy because of side effects. It took many many years of all sorts of antidepressants that only helped a little and made me feel more agitated before my psychiatrist of 8 years diagnosed me with bipolar 2, which is different than classic bipolar 1.

I have frequent bouts of depression, and sometimes develop hypomania- usually lasting a few weeks. These are good times- lots of energy, more productive and creative, outgoing, and euphoria. Never becoming psychotic or anything requiring hospitalization. If you didn't know me you would just think I was a very positive, energetic person. So what's the problem? I start getting edgy, anxious and irritated, followed by months of depression. Hypomania does not always come after depression, but depression Always follows hypomania. Way more time is spent in depression. Tracking moods, behaviors, sleeping habits, use of addictive substances, etc., for years helped make that diagnosis. I was put on a mood stabilizer earlier in treatment and it helped a lot. But I stopped taking it because I felt good and thought I didn't need it. Shortly after that is when my affair with opiates began, and only many years later was I put on it again. By then I was fully addicted. My mood stabilizer has helped so much, but I kept screwing it up because whenever I was binging on opiates, the whole mood cycle would start again. So, even though it may sound trendy, I know it is a real thing, and it's not much fun. Doing well on mood stabilizer, antidepressant and Bup.

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PostPosted: Sat Apr 22, 2017 7:12 am 
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Some of the real work I've been avoiding for 20 years is going to begin now. It's only been touched on briefly in support group settings but never intensive one-to-one counselling.

It's interesting though that my shrink has never delved into it, and any time I've started to bring up my past he evades the topic. Is it easier to medicate than provide actual therapy?


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PostPosted: Sat Apr 22, 2017 11:39 am 
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Good morning Teejay, or good evening to you where it is in AU!

To try answer, imo and/or ime:

depends on their training
depends on their personality and beliefs
are focused on the med mngt with all it takes to learn and understand the meds and how each will work in each patient along with the other meds the patient is also on. In other words, stay in their own silo or smokestack.
don't know or trust a 'good' therapist to refer you to and who works for you may not click w another patient
don't think the patient can handle therapy bc not stable and may worsen during/after therapy.
believe if the patient only has resources (time and/or money) for one treatment, it should be for meds.
some Psyche Drs don't believe therapy is helpful
IDK, could be lots of reasons...

One PhD therapist I saw for individual and group did EMDR (Eye Movement Desensitization Response) and her patients did well. Referrals mostly came from non psyche MDs, OB/GYNs, Internists, Primary care.
Not sure what your search engine will pull up in AU so I'm posting links in case you're interested. She uses it for past life trauma, repression, PTSD including veterans. She only did EMDR if patients were on their meds or had no history of meds. She never allowed stopping meds bc slowed/confused/upset the process.

EMDR Institute
http://www.emdr.com/

New York Times Blog on EMDR
https://consults.blogs.nytimes.com/2012 ... -d-r/?_r=0

Current Clinical Trail Looking at EMDR for relapse prevention for bipolar patients with a history of trauma. If you click on the Clinical Trails link w in the article, at the bottom is a list of additional publications on co-occurring BP and trauma.
https://www.ncbi.nlm.nih.gov/pubmed/28376919

And search pubmed for EMDR as well. Lots come up.

Separately, I like massage bc it increases oxytocin, a social bonder and decreases stress hormones. This helps feel connected w others and belonging to this world. its important to be touched by another. Sex for sex sake feels good but massage is broader response and affects all relationships and imo, is especially helpful for those that live alone, ya, its important to be touched by another. Friendship hugs, handshakes in greetings, gesturing and touching an arm or hand in conversation...

That's the thoughts that came to me in response to your really interesting thread. Best always Teejay, Pel

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PostPosted: Sat Apr 22, 2017 10:25 pm 
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Thanks Pel. Yeah massage sounds promising given a gym injury I sustained last year.

Honestly I just feel like I've been running far too long. My life has become a never-ending Basketball Diaries, and it's keep running to the death or start talking and confronting stuff. It's SO easy to practice avoidance when you're on close to 1 gram of lithium a day, 1 gram of valproate a day plus an antidepressant plus zyprexa plus Suboxone.

And I see people in NA who have SEVERE bipolar, manic 24/7 with no depressive episodes as a result of childhood trauma and abuse, yet they manage to get by on zero psych meds and zero Suboxone after working a solid fourth step and baring their soul and finding a higher power.

Something's gotta change, because IF I keep using every time I experience severe depression, I'll end up dead, whether accidentally or intentionally.

And yes I do live alone. I actually live with a cat so I don't consider myself alone. Having my own place is better than living with the kinds of people I find myself sharehousing with usually, though I do try and get out and meet people as much as possible.


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PostPosted: Sat Apr 22, 2017 10:49 pm 
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Teejay, I hear you, I hear you. I have no idea if you have access to emdr but in the therapy group I was in, I saw how it was powerful and successful for confronting the past. And safe bc it can be slowed and made very comfortable to what can be handled. And BP folks there felt they'd failed the 4th step, but at that time I didn't know what that was... I was in group therapy and 4 in the group were doing emdr w the same therapist which is where I learned of it and saw its power and success. I know you're a reader and researcher which is why the links. The clinical trials are in Spain bc I checked locations if any near you. The massage was not meant in disrespect, its a tiny add on for me. I also can maybe tell you are a skeptic, naturally so bc of all you've been thru and bc of your thinking brain. I truly wish you my best and do follow BP and depression therapies w you in mind. Pel

Edit:one guy was abused by a priest and one abused/tortured in cuba yrs before. One by his wife. and one gal was early childhood issue where her mom routinely left her at various churches for days..

Edit again: seems like you are ready to talk w your AOD counselor and start maybe opening up. Not sure - is that something you're going to do?

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PostPosted: Sun Apr 23, 2017 1:56 am 
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Yep definitely Pelican going to open up. Government funded drug & alcohol counsellors are trained in trauma counselling in Australia just because of the prevalence of trauma in substance abuse issues. Also the perpetrator of my trauma was jailed recently for his behaviour which makes me think it's time to actually deal with it.

I know it won't be a cure but hopefully it'll lead so some self-acceptance and understanding of why I choose to destroy myself like I do.

I'll check out the links you posted now.


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