Podcast: Play in new window | Download | Embed

Subscribe: Apple Podcasts | RSS

Hello, friends! This is a great Q&A episode where I answer listener questions on a variety of topics including how to make your doctor take your seriously, catching emotions in the moment, and addressing a one-sided sexual relationship.

Special Announcement!

Hey, I was wondering if you could address this problem in one of your shows that I’ve been struggling with for a long time. I’m sure if it’s happening to me, it’s happening to a lot of people. I was diagnosed with anxiety years ago, and I was having panic attacks and just feeling overwhelming fear that stopped me from leaving the house. Then I learned how to cope slowly and got much better for a few years, to the point where I don’t really consider myself very much affected by my anxiety at all.

In the last year or so I started to have physical pains on a daily basis. I went to the doctor, and they told me it was my anxiety, but I didn’t FEEL anxious. I went through therapy, and the therapist told me the same thing, that it was my anxiety and I needed to just accept that I was going to have physical pain from my anxiety for the rest of my life. Well, I got fed up of being in pain on a daily basis and mustered what money I had to go and privately see a chiropractor (I had a hunch, since the pain mostly manifested in one leg). The pain was all coming from a problem in my back which she took care of, and the pain went away. So, it turns out, I was correct, they were NOT ANXIETY related symptoms. I feel like I cannot go and see a doctor about any health issue without them finding a way to tell me that it’s an anxiety related problem – worse, I feel like every time I got to the doctor to express concerns about my health, it further condemns them to view me as having a health anxiety problem instead of trying to find a legitimate issue. Is this a common problem? Is there something I can do to get my doctors to respect the progress that I’ve made in managing my mental health?

Yes this is a common problem. And yes it sucks. One of the issues that comes up in a lot of healthcare networks is the “problem list”. I encountered this when working at a healthcare facility during my predoctoral internship. On my screen when pulling up a member’s records, I saw a list of “problems” along the right side. Basically everything that has ever been a confirmed or working diagnosis. There were some people with way too many. The problem is people rarely take things OFF the problem list. So as a result, I might see someone that has depression, anxiety, grief, bipolar, panic disorder, PTSD, BPD, etc. when I know they don’t have ALL of those things.

My wife and I run into this issue pretty frequently, actually. If you’ve listened to any of our talks on the podcast, you know that she has anxiety and probably bipolar II. She has had serious issues with people not taking her seriously because of that. She also has some odd chronic stomach issues that nobody can figure out. It’s clearly not JUST anxiety, but tests keep coming back mostly normal and it’s been tough to feel like she’s getting written off. It leads to a decreased desire to follow up, instead opting to just deal with it. She also had difficulties when she didn’t want to follow the same tracking protocol that her doctors wanted during her pregnancy due to gestational diabetes. They put “medical noncompliance” in her chart. This led to her being scheduled for an induction without even being asked if she wanted one for her second pregnancy. I will say that this can absolutely happen to anyone, but it’s especially a problem for those that identify as women. So yes this is real and it’s a problem.

Getting your Doctor to listen…

Now, what can be done about it. Unfortunately, on the micro-scale, a lot of this comes down to you and your support network. You need to advocate for yourself. As with most things, I like to start with the least intense “intervention” and work up from there.

First step would be pre-empting your doctor’s objections by helping them understand what you’ve been through. You could say something like:

“Before we get into all of this, would it be okay if I tell you a little bit about what I’ve been through, because I find that some doctors get the wrong impression of me? I struggled with anxiety for a long time and did XYZ types of treatments to work through it. As a result, I went from not being able to even XYZ to being, for all intents and purposes, anxiety free. I do recognize that there is a significant link between mental health and physical pain, and I’m not neglecting the mental health side of this. But I know my body and there is something more going on.”

If you don’t feel like you can speak up for yourself in that way, then it may be helpful to bring a trusted loved one with you that could or give them permission to call into the doctor to speak with them. If you feel like you aren’t being taken seriously, you can speak up about that. If after speaking up about it, you feel like you still aren’t being taken seriously by the doctor or you are getting worse treatment because they are annoyed – that’s where you may want to consider getting a second opinion/switching providers. At some places, you can try simply switching to another provider within the same system. For your next appointment, you can ask the staff to not schedule you with the doctor that you had a hard time with and instead schedule you with someone else. You can also look into other doctors entirely. If you can find a doctor that has a specialty that is relevant to you like pain management, chronic illnesses, etc. that might be a good candidate. Unfortunately, when you live in certain areas, you might not have as much access to these awesome providers. Online reviews can be helpful on websites like yelp or healthgrades, but just keep in mind that medical reviews are really skewed because most people don’t feel comfortable violating their own confidentiality to leave a review. But if you see a positive review noting how the doctor took someone seriously, that’s a great sign.

If you can’t find someone in your area that can treat you appropriately, at least you can advocate for yourself. Get some outside perspectives to make sure that you are thinking along the right track and then remember that you are the patient. You have the right to refuse suggested interventions or services, you have the right to view your medical record, and you have the right to be taken seriously.

Sometimes there are issues that you can identify through other people who have been through something similar. For instance, a lot of unique drug interactions or side effects are noted once there are a bunch of people reporting strange experiences online. In other cases, there might be new research on a topic that sounds like what you are going through. You can always bring in articles or pieces of information to your doctor. However, when doing so, please keep in mind that they are going to be sensitive to patients essentially trying to direct their own treatment. Not in an egotistical sort of way, though that can happen too, but more like they want to make sure that they are trying to stay as objective as possible and view the situation through their training rather than allowing outside influences to paint their diagnoses.

All in all, it is a real problem as I said, and you are justified in having strong feelings about it. I want to stress that YOU are the expert on you. Nobody else can tell you what it feels like to be in your body. Don’t let anyone take that away from you. You may not know how to make sense of it, but you alone know what it feels like.

Hi, just found the podcast recently and have learned a lot so far. I have a question for the show. I am trying to better my emotional control/not let my emotions react and get the best of me, and I’ve listened to some of the advice you’ve given on the subject in various episodes (such as the future self technique and others) but what I’m struggling with is… I find it hard to remember/enlist the actual techniques when I’m in the heat of the moment. Do you have any advice on how to recall these tips or commit them to my mind when it matters most? Thank you for your time.

Welcome to the podcast! If you haven’t yet, definitely check out our community on Facebook! Also, good job trying to make a positive difference for yourself. It’s not easy and it sounds like you are working really hard at it.

You’re pointing out a very fundamental issue when it comes to using coping skills that you might learn in therapy, through podcasts, or by reading self-help books, which is that it is definitely tough to make that leap from intellectually understanding something to putting it into practice. So you’re not alone in this. It’s hard when you are actually under the gun. At a neurological level, the more primitive emotional parts of your brain start to overwhelm the more logical frontal lobes of your brain with too much raw emotional input. This makes it hard to engage with reason and act in the way that you would like to if the situation were written out on paper.

There are a few things that you can do about this. First off, recognize that the process always starts after the fact. You run into a scenario, it doesn’t work out the way that you would have liked, then you look back on it and try to see what you could have done differently or try to look at it through a different lens. The more you practice this, the more it will become second nature. This is definitely how it works when you are doing something like an ABC thought log. It takes a while to learn the process enough to integrate it into your automatic thought processes in the moment.

Step back and take a moment

A lot of what I teach is also trying to help you get a little bit more space to respond. It’s the simplest thing in the world, but finding a way to cue yourself to just wait a moment before responding can make a huge difference. Rather than letting your limbic system send signals at you like a bat out of hell, you can allow that raw input to settle for a moment. That will make your next move so much better. I’m imaging situations where my little one, Leo, has bit me. Normal thing for a kid to do, but it’s also normal for someone literally biting your skin to make your brain freak the f**k out and go into aggression mode. My primitive brain wants to chuck the little bastard out the window, but simply taking a very forceful deep breath can make a huge difference and allow me to set him down somewhat gently and then walk around cursing because it hurt like a motherf****r. So identify your best ways of cuing yourself to take a moment. Literally turning around and walking a few steps away, closing your eyes and forcing a deep breath, or simply holding up a “wait” finger while you process can be the difference between a major reaction that you regret and a more reasonable reaction.

DBT is a type of therapy that I’ve talked about a few times on the podcast. It mainly focuses on the management of strong emotional responses. So if you haven’t looked into it, you might try out some DBT therapy or grabbing some DBT books could be a useful tool for you. One thing that DBT does is provides a lot of acronyms for their techniques. These are meant to be easy ways to remember what the steps are, which can make it less effortful to pull out in the moment. For instance, STOP is a popular acronym in DBT, which stands for Stop, Take a step back, Observe, and Proceed mindfully.

Now one thing that I will advise you to look out for is trying to have too many coping skills that you try to use at once. It can be even more overwhelming when there are so many acronyms or skills to choose from, but you can’t remember which is the most relevant to the situation at hand. I advise sampling a lot of them and seeing how well they sit with you. And then coming up with just a few “back pocket” strategies that you can train and master. When I say train, that means practicing them often. Breathing would obviously be one that requires training to teach your body how to come down from stress in the moment. For other skills, you might actually invite some stress to try them out. For instance, if talking on the phone makes you feel really anxious, calling to make a doctors appointment can serve as a great chance to practice a coping skill. For me, simply telling myself internally to “pause” does the trick. If I’m spiraling or feeling like I want to make a big emotional response to something, I say to myself (or out loud), “Okay. Pause. Hold on.” Then I take a big deep breath and just think for a few seconds. This makes a huge difference from me and allows me to make a more intentional choice with how I decide to act.

So just some food for thought. Hopefully that helps to normalize the experience and give you some ideas that you can try to better catch yourself in the moment.

So my boyfriend and I have been together for over a year now. The relationship is wonderful. I mean we get along really well together. Before I met him I took a 2 year hiatus from the dating world to get my mental health together, to live myself again. Once I got to a place where I felt I was truly ready to give love a chance, my boyfriend came waltzing in.

Although our relationship is great. Our sex life is not. I was on a 2 year hiatus from dating and sex and when I met him I still wasn’t ready to have sex again yet. But my boyfriend was ok with it because he is a virgin. But now after 18 months I want to take that next step but every time I try to initiate with him (please him sexually) he always stops it, which I respect because consent is important, but he is always ready to please me sexually and doesn’t allow me to return the favor.

I guess my question is: is it normal for me to feel disappointed when he turns me down like that? Is minor resentment in that category normal? How exactly do I go about talking to him about how I feel towards our lack of intimacy in a way that does not come off aggressively or demeaning?

Hi! Awesome that you have been able to make such progress. A lot of times, people are scared of taking breaks and working on themselves and for good reason. It IS work. So great job. Also happy to hear that things are going well for you in most respects with regard to the relationship. That helps because you have established a strong foundation that can hopefully withstand some talks about important topics.

I think that this is something that you are definitely allowed to have feelings about. Sexual desires and needs are real. You haven’t jumped the gun and gotten emotionally angry or vindictive about it, which is great. But if it’s a need that you have and you are starting to struggle with not having it fulfilled, it’s at least something that you should be talking about. Neither of you are right or wrong in this situation. It’s just the reality of the situation at the moment. I think when it comes to sexual issues, these are deep primal feelings that sometimes find a way to bypass your logical brain. The way that you think about something on paper can be very different from the way that it hits you in the moment. For example, if you had a friend that was going through this, you would probably say to them that their partner’s lack of interest in receiving pleasure is not a reflection on them. It doesn’t mean that they did anything wrong or that they are inadequate in any way. BUT when it happens to you, your primitive brain might be instantly hurt and feeling like it’s something that you’ve done wrong. That you’ve been rejected. We don’t have a ton of control over how we feel, but we have some control over what we do about it. You should honor the feelings that you have AND recognize that they may not represent the truth or might be a little unreasonable in certain ways.

Talk about it

So yes, your feelings are normal and I think it says a lot about the respect that you have that you’ve respected his wishes and haven’t gotten mean about the issue. I can’t tell from your question if you have communicated about this yet at all. There is no perfect way to talk about this, so don’t stress yourself about getting it exactly right the first time. One thing that happens when you don’t communicate, though, is that you can only imagine possibilities. Rather than finding out what is going on, you have to make assumptions. Is it because he is actually asexual? Is it because he’s unsure about his sexuality? Has he had trauma that isn’t worked through yet? Is he super scared about something specific happening the first time? Who knows! When you don’t talk about it, all you can do is assume and that can drive you crazy because you likely start to default to more negative assumptions that say something bad about you.

I think when broaching the subject, it would be helpful to be honest. To say that you are trying not to make any assumptions and that you are not mad at him. You do wonder why he doesn’t want it though and you do struggle with feeling like you are being rejected even though you know that’s probably not the case. Let him know that you aren’t thinking of leaving (unless you are), but you just want to better understand what is going on. Maybe it’s something deeper that’s going on or maybe he’s just nervous about it. It’s something that may not be fully revealed or settled in one talk. You can always come back to it and shouldn’t be afraid of following up. Often, it’s really hard to first talk about it, but from there it gets easier. You also both have time to think about it in between talks.

Start with discussing it. If he is unwilling to open up or if things do not change in any way and you don’t think that you can cope with being unfulfilled in that way, then the conversation needs to change. There are many different directions that you could go with it. Therapy, nonmonogamy, moving on to someone else. All of these are jumping the gun, though. You gotta talk about it first. Don’t assume.

Thanks for Listening!

If you know someone else who might benefit from today’s show, please do share it with them. Send them a link or shoot over a screenshot, and share it on social media to show your support – you never know who needs to hear this type of information.

Show request?

Got a topic or a guest you’d like to appear on the show? Or interested in having Duff answer a question on the podcast? Please get in touch! Email Duff and maybe you’ll hear it on a future episode!

Want to help out the show and Duff the Psych?

• Subscribe to the podcast on iTunes.
• Leave a podcast review on iTunes. These reviews really help Duff reach potential listeners, and he appreciates every one!
• Share the show on Facebook or Twitter.
• You can also buy Duff a cup of coffee, which helps fuel the energy that goes straight back into creating more content for YOU!