Got a question related to mental health? ASK DR KIM

[Chris_B]

Hi everyone,

This is a thread for asking questions of our resident GP and counsellor, Dr Kim, who pops into the forums regularly.

PLEASE NOTE as per our community rules, Dr Kim won't be able to answer questions about medications, these are best discussed offline directly with your mental health professional.

UPDATE - 01/03/2018
BEFORE YOU ASK DR.KIM PLEASE CONSIDER THE FOLLOWING POINTS:

• Dr Kim's time is limited! We cannot provide an ongoing dialogue with Dr Kim in this thread - one post/question per person please
•  We'd recommend you have a look through the forums before posting here to see if your question has already been answered by Dr Kim, our other members, or if there's information about it already on the beyondblue website. If a question pops up that has already been answered previously, or if alternate resources are available, one of our moderators will reply and direct you to the link.
• When writing your question, imagine you are speaking to someone in person i.e. provide a clear and detailed post with enough information that outlines how Dr.Kim can help you.

Background

After 20 years of experience working as a GP, Dr Kim realised in 2003 the aspect of her work she enjoyed most was talking to people and understanding the way they think and behave – and so she underwent training in counselling and therapy, where she now solely works.

Her experience includes working with a wide range of mental health issues including anxiety, depression and adolescent mental health.

“Given my training I also see couples, siblings, parents with their children and entire family groups,” she says. “In this work I hope to give families the skills to understand one another and have the strategies to communicate and manage relationships that are distressing them. I believe strongly that best therapy is achieved when there is trust in the therapist's ability but also their genuine desire to understand and help.”

[Dr_Kim]

james1 said:

Hi Dr Kim,

if there's nothing wrong with my psychologist and I feel comfortable revealing things, yet I still want to lie to avoid situations I create in my mind, do I persist or leave?

James

Hi James, I firstly want to applaud you on all the hard work you have done to get to this point. You may not know this but you are doing brilliantly! So many people with BPD can’t even acknowledge that they have it .. ( they remain stuck in the notion that there nothing wrong with them, but its all everybody’s else fault and if only everyone would be nice to me I would be fine ) . 

So you have come so far already in that you have taken responsibility for yourself and can be mindful of the way your BPD can impose a certain lens on the way you see things . For example , you say that you know its irrational but you have an urge to want to ditch people before they possibly ditch you. Well, this is understandable in BPD, as the fear of rejection and abandonment is so often a major feature this disorder. Similarly, this is often a reason why those with BPD lie and “mould"… to avoid rejection and abandonment. 

My advise is NOT to leave this therapist . Her limited availability is actually a really good opportunity for you to work through an important issue for you. That people can care for you but not always be available for you. That you need to not be black and white in your thinking about this. It is your BPD that makes it seem that if people are not either always there for you or saying the exact “right” thing ,then it means that they don’t care and are therefore a disappointment . If you make such high bars for people, they will always fail and you will always feel let down by those around you and you will find it hard to trust people . But it won’t be because people are bad, but more because you are putting that tough BPD lens on and really setting them up to fail. This therapist is not failing you. She is behaving exactly as she should with appropriate boundaries. 

Please use this wonderful opportunity to talk openly with her about how it feels for you . This is how people build openness and intimacy - they discuss difficult topics, tolerating the anxiety of the fear of rejection.

If it helps, print out this post and take it to her… You are doing really really well, I promise. Don’t stop working on this now!

[Just Sara]

Good evening Dr Kim;

Firstly, I love the above post to James. It opened my eyes about BPD...thankyou.

I'm being pushed by Centrelink to go back to work. I've worked hard to recover from my break-down at work Sept 2014 (and then medically retired by employers). I've had much success with changing my communication and beliefs, and wonderful peace from stepping back from conflict to assess my part better.

Walking into another workplace with people has me scared to death. It's one area I just don't think I have what it takes to deal with anymore due to PTSD from bullying and harassment over a 7 yr period. The 'team' dynamics are too close to my childhood (family) PTSD. My psychologist and I discussed Exposure Therapy yesterday. She feels the risk of a relapse is too high and I agree with this. I don't ever think I could desensitise myself to a lack of trust.

My question is: Does Exposure Therapy always work, or to a certain degree for instance? Working is the only area I haven't been able to make any progress.

Thanks heaps...Sara

[james1]

Hi Dr Kim,

Thanks for the reassurance. It's very hard dealing with it on my own and I get very disenchanted with my progress, and having no one to talk to in person about it is very hard. I feel like I always need to be talking to people because I'm always questioning everything and I'm seeing a lot of the traits filtering through my behaviours even just with my friends. It just feels like I'm not only amending my current behaviour, but also addressing all these past behaviours which continue to shape who I am to my friends.

Anyway, I will continue to work at it.

James

[Pixie15]

Hello Dr Kim,

I am not sure if you can help me.

I am uncertain if I have anxiety because I am in a difficult relationship or in a difficult relationship because I have anxiety.

A clinical psychologist I saw a few years ago suggested it was a learnt behaviour. I have made some positive changes with making use of the different tools that I learnt but I still asked my GP to prescribe an antidepressant earlier this year to help with the social anxiety. I have always been shy so doing new things is difficult. My partner who suffers depression is bothered by my doing new things and I find this a bit of a double whammy. Also because I lived with my partner for many years trying to accommodate his depressive symptoms without realising I had been caught up in the antisocial behaviour I have trouble trusting my own judgement now.

I am not sure what to do. I also tried relationship counselling last year but could never get to the point of telling my partner that I was seeing the counsellor.

I do not know what to do next.

If you have any ideas I would appreciate a response.

[Andrew_985]

Hi my partner is suffering from double depression and agitated anxiety and has no energy . She spent 3 months in hospital and had ect which has caused her jaw to clench and she just cannot cope with life at present . She keeps asking me to help her but I can only do so much and find this exhausting

I wondering if there is anything else I can do , I am her full time carer

thanks

[Andrew_985]

What is exposure therapy ?

[Just Sara]

Hi and welcome Andrew;

I'm sure Dr Kim won't mind if I hijack her thread to invite you to join our forum conversations. It's always nice to be greeted by someone when things are so new and life is getting on top of you.

We have many related threads (topics) that will certainly interest you or give some relief to your situation I'm sure. Please feel free to surf the sections or post (write) an introduction (about yourself) in the Welcome and Orientation section; we'd love to hear from you!

There's also the option of creating your own thread; 'What's Exposure Therapy?' for instance.

Thankyou for joining our caring community here on BeyondBlue Andrew. Keep an eye out for Dr Kim's response ok?

Kind thoughts...Sara

[GuestYD]

Hi Dr Kim

My psychiatrist has reduced my sleeping tablet by half, with the view to cut them out completely. I have been on most sleeping tablets during the last 2.5 years. I have not been able to get to sleep at all and it's 2am. I took my tablet at 9pm and my antipsychotic med then but I did not get to sleep. I'm already at a half dose of the antipsychotic med, but we stopped dropping it further as I had really bad nightmares and flashbacks. But once I'm on holidays she's going to try and reduce that slower. I mention both meds as they both have sedative properties.

I have tried a number of sleep techniques and there are some useful ones which I think have helped. Do you have any tips for someone who has gone from sleeping tablets to normal sleeping patterns and an idea of how long that adjustment period will be?

Thanks

LC

[Sophie_M]

Hi Andrew, you can find information on exposure therapy on this page of our website.

[Dr_Kim]

Sara_Conna said:

Good evening Dr Kim;

Firstly, I love the above post to James. It opened my eyes about BPD...thankyou.

I'm being pushed by Centrelink to go back to work. I've worked hard to recover from my break-down at work Sept 2014 (and then medically retired by employers). I've had much success with changing my communication and beliefs, and wonderful peace from stepping back from conflict to assess my part better.

Hi and thanks for the feedback re my post.

About your situation of pushing yourself therapeutically .. I have mixed feelings about it. I do believe that sometimes in order to overcome some fears, we have to get a bit uncomfortable. This is even given a name in OCD treatment regimes where they ask patients to NOT act on their compulsion and then sit with the "NQR" , the "not quite right " . Meaning, they know they are provoking a horrible feeling in the person .. they know they are asking people to learn to tolerate feeling bad and resist relieving it with their habitual compulsion.  Gradually people do learn to tolerate the feeling , the "NQR" and can resist. But it's not an easy journey. 

So back to you . Do you feel exposure therapy a "necessary" but difficult step on your journey ? Do you feel you can work productively avoiding triggers such as a work place or do you feel that is unrealistic and you really want to have the strength to feel that you will be ok in most situations? Have you discussed all other alternatives including medication?

I feel this therapy can only work if you feel SUPER safe and supported. That you feel connected to both parts of your brain at all times .. that you feel the " healthy " part calming and guiding you whilst your anxious, traumatised part tells you that you are in danger, or something awful is about to happen .. 

If you don't feel SAFE then don't do it , if you feel that you don't want to do it because it will be hard , then do it ( as the hard part is the part which also helps you to feel strong and healed ) .

I know I'm not being absolute with you .. and that is because it's a hard call . It doesn't always work , it may make some people worse ... but on the flip side, for others it is a hard but wonderful release from fears that they really want to let go of or manage better . 

I do think in general, it works a bit better on phobias than PTSD .. but every case is different. What's great is that you are having open discussions with your therapist about it all . 

Good luck.