It’s difficult to evaluate a psychiatrist during a 50-minute session — and then decide whether to see them again — when the real value of the relationship may come years and hundreds of sessions later. This problem becomes even more compounded because you rely on this person in order to get the medication you need to function like a halfway normal person. 

Nobody brags about needing to be on anti-depressants. In fact, it’s still something that people feel the need to be hush. Because no one wants to be a failure, and the world has made it clear that people who are on antidepressants are somehow weak, even though it’s no more different than someone who might be prescribed insulin for diabetes. The truth is, sometimes our brains need a little help too.  But that’s another thought for another time… what I wanted to talk about today is what to do when your relationship with your Doctor goes south (In a sense though, both topics go hand and hand).

There are no referees in the room; it’s just you, your psychiatrist, and whatever problems you’re facing or want to unpack. Sometimes, the relationship starts out great but erodes over time or lingers for years without inertia, or you call it off for small, seemingly silly reasons. And sometimes, there are incidences that lead to only one course of action. FInding a psychiatrist is hard. Finding one who takes your insurance is even harder. I had spent a little over 2 years with who I thought was the right Dr. I mean, we went through a fricken pandemic together, I thought we’d be in it for the long haul. I was wrong. 

I had so much invested in the relationship at this point—money, time, and my innermost demons—that I didn’t want to rewind my progress or start over from square one. So when things got particularly nasty over an insurance situation I was hesitant to leave at first. 

The problem was that she was out of network, but we had taken care of this issue right when I had begun seeing her. We had put in for a preauthorization to see her, which was approved by my insurance. At some point, I’m not sure when it was no longer approved by my insurance. There was some back and forth on this and we had both tried talking to my insurance and that is when things got nasty. The insurance company insisted it was because she had never put in for a new renewal for my visits and when I told her this she would get defensive and told me I wasn’t saying the correct things to the insurance company and that it was my fault. 

I never felt like I could talk to her about the situation without being demeaned or being accused of doing something wrong. She told me several times that I wasn’t doing what she asked me to do but I never knew what that meant or how to respond because what she was telling would contradict the insurance. In one particular nasty text message, I got scolded for not getting the first and last name of the person I spoke with about my insurance. When I told her, they only provided a first name she scoffed at me. Later, when I inquired with my insurance on this they told me it was in fact a violation to give out first and last names. 

I was crushed by her comments and stunned by how mean and insensitive she was being. After all the work we had done together around my issues, how could talk this way to me? It seemed like a cruel joke or a very insensitive mistake. I spent days agonizing over her text messages and every time she would reach out to me, it would end with me in tears and having a panic attack. Finally, it got to the point where I told her, I would do my best to try and figure this out, but afterward, we should end our relationship together. It wasn’t healthy for me and it was causing me distress and panic attacks. I won’t go into detail on how she responded to that, but spoiler alert, it was not well. 

We ended up having one last “session” together because I think she realized that some of the stuff she was sending over text messages was not the most secure. The session ended with me in tears and slamming my laptop on my virtual appointment. I was happy I stepped away, but it left me feeling very shaken. I knew I had to end this toxic relationship, but now I also had to figure out how I was going to get my medication. 

I was walking around trying to process it for weeks. Everybody I had talked about the situation to or shown the messages to were stunned. Luckily, I have a very good relationship with a therapist I’ve seen off and on for years. We set up a meeting to come up with a new game plan for my mental health. Unfortunately for me, not being on medication is not an option. A fact I still sometimes still have problems coming to terms with. I eventually came up with a solution for my situation because I really had no other choice- but it’s not ideal.  

It empowering however and kind of cathartic to walk away. Often, it can be tempting to just resign ourselves to an inadequate level of support. We’ve been taught to never question the competence of our clinicians, without realizing that they aren’t always a good fit. You deserve a  physiatrist or therapist that you like, respect, and who makes you feel good. If who you are seeing does none of these things for you, don’t settle for less. You are allowed to “fire” your physiatrist. And if it could improve your health, there’s no good reason not to.

❤ Sweeney