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18 April 2017

One last try

I'm trying to approach things from a less... emotional (maybe that's not exactly the right word) point of view here. Anyway. One more try.

At my last VA appointment I had a social worker ask me questions and type my answers into a computer, in much the same way as I used to ask customers questions on the phone filling out help desk tickets. One difference is that I had to wait a month after an emergency room visit to get my appointment, and another is that this last appointment the person has a master's degree in social work. I'll assume she's paid a certain amount based on that, which is probably much more than I got paid as an IT support agent who was also an undergraduate, for what is essentially the same work. Had this been my first ever visit to a mental health clinic or appointment with a useless social worker, my feelings might be different, but it wasn't and so I'm just not happy.

That appointment resulted in a phone call from someone in trauma recovery. I called back, left a voice mail, and then didn't hear anything for about a week. When the person did call back, they called at around 0800. I've asked everyone I've encountered at the VA to not call until after 1200 because I'm up very late every night, and before noon I don't hear the phone right because I'm asleep. I've been asking this for years. In any case, I happened to be awake because I'd been unable to sleep for about 24+ hours, so right after I missed the call I called back.

Turns out the person had been out of town, and that's why they hadn't yet called back. So whatever they had to go out of town for was more important than either calling me back to set a date and time, or to assign someone else the task of calling me back to set a date and time. You could argue that I'm being unfair, that life happens and people need to do things like go out of town all the time. Fine, but this person isn't the only person that works in whatever office this is. If I'd ever used that excuse with a customer when I worked help desk (sorry, didn't check on your ticket because I was at a hackathon) I'd have been fired.

So I have an appointment with this person tomorrow afternoon.

It's at some other building that I haven't yet been to, completely separate from the VA hospital. I have to go through/past a mall of some sort to get there, which doesn't sound appealing-- I'm not in the best frame of mind in terms of either patience or concentration, so I'm not especially looking forward to the drive there. I haven't been able to find out anything about the place itself, other than to get directions there and see a picture of the building on Google Maps. It doesn't look particularly dangerous, but it doesn't look particularly friendly either.

During the phone call, it was mentioned that I need to bring a DD214 along. When I asked why, the person's response was that the clinic needs it. Why? It just does. This is bothering me a great deal-- there's nothing on my DD214 that the VA doesn't know already, and in fact they've had a copy of the thing since 1992. The VA already knows that when I was in, what branch, what war, where, and when (and if they didn't know before, those questions were all asked by the social worker at my last appointment and they didn't need to see it).

It's not unreasonable to question being asked for a DD214. There's nothing really "secret" on it, but it does contain personal information and I'd really rather minimize the number of people in the word that store copies of it. More important, when I asked why it was necessary I was blown off. I need to be able to ask questions of the people who are providing my mental health care, and as a patient I have the right to do so-- being blown off about something so simple before I even go to the clinic isn't a good sign.

I'm also bothered that this has all the indications of being another intake appointment, where I sit in front of still another person and explain everything yet again. That's been the theme for the past few years, that every new provider is me reading my biography-- it was true in Wisconsin, too. I'm not expecting the VA to be like Cheers where everyone knows my name, but at the very least I shouldn't have to explain the whole story again and again. The story of how I got here and why I'm in the mental health clinic is long and ugly. It's triggering to have to sit and think about it (which is the reason I want to do work in therapy to begin with). I expect that this appointment will just result in another appointment, likely with yet another provider. If it's with yet another provider I'll have to tell my story again in a week or two weeks or a month before any therapy happens. Given wait times so far, that puts my start of therapy into May, or possibly June.

What I want to do, at the very start of the appointment, is ask "is this appointment going to result in me starting therapy at some definite point?" If the answer is "yes", then all right-- let's skip the bullshit and let's talk about the logistics of that. If the answer is "no", or anything other than yes, then I'm done. Words like "maybe" or "that's what we're here to talk about" or "we need to evaluate" are, right now, the same as saying no.

It's not that I don't want to do the hard stuff in therapy. I do.

Cognitive processing therapy is in some ways harder than prolonged exposure therapy (which it difficult too), because you have to think about what's going, on, question it, and write down answers-- and you have to do these things for every week for three months. You end up thinking about the therapy, and your questions, and your answers, for a lot of the time in between weekly sessions. It's serious mental pick and shovel work.

If I were looking for a quick fix, CPT isn't where I'd look. I'm not being a hardass about getting what I want from the VA because I want a quick fix or an easy answer.

All or nothing thinking is actually something that comes up in cognitive processing therapy, it's often an indication that important details are being missed. I'm trying to consider this when I say that if at tomorrow's appointment it's not immediately clear that I'm going to get into therapy, I'm going to bail. It is perhaps a stuck point for me that I went to the emergency room for my PTSD symptoms being bad and nothing really happened as a result-- I'm the only one that seems to consider this as being important. (Of course, I still consider it important that that VA put me back on the street and forgot about me in 2014, too.)

One of the things I've learned in all of this is that you don't take steps forward through PTSD until you're ready for them. The reason might be fate, or a higher power, or just natural selection-- I have no idea which-- but a lot of the forward progress I've made couldn't have been made any earlier. The rule is often that you can't get there from here, there's lots of small steps to make first. It's only after a lot of these steps that you look back and see that you've made progress.

Right here, right now, may well be one of those places and times where getting into therapy just isn't "supposed" to happen. Might be it's just chance, or that the VA's really just that dysfunctional here, or a combination of both. In Wisconsin, I always just sort of took what I was given. That's how the VA is set up, you don't really go through the process of choosing a therapist, you just get assigned the next one who has room on their caseload. If you really don't like your current one you can ask to be switched, but usually no one explains that.

I've been writing here (this blog) since 2008. There's a lot that's not included, but there's a lot that is-- I tend to shoot from the hip when I write, and what gets put on paper stays there. I'm careful to not attack people personally, which is why I use things like SW or Social Worker or Front Desk to refer to people I'm writing about. I know who the person is when I look back at previous posts, and especially lately I use those posts as guides to think about some of the therapy I've had before, what worked and what didn't-- and who worked and who didn't.
 
Before I ever was diagnosed with PTSD, I was diagnosed with social anxiety and was in a therapy group for that for about a year, every week except holidays. I have some, but not all, of both my notes and the psychiatrist's notes from that year. One of the very important things that came out of that therapy was the idea of subjugation, putting the needs of others before my own needs in relationships with other people. It's not a bad thing to be a generous and giving person, but it becomes a bad thing when you don't get what you need to be happy because you're not in a situation where you can ask for it. You end up giving until you're empty. One of the ways you counteract that is learning to stand up for yourself and not accept being put upon. This is why when the Vet Center canceled that appointment I had in February, I got so upset-- I was doing my part, but they were not doing their part.

I know that relationships such as romantic relationships and that of being a patient in a clinic are not the same, but in a clinic or hospital where it's your job to help patients you're obligated by that to actually help patients. You get paid. When it's the patient that's having to do all the work to get help, something's wrong. When I'm the patient and I'm asking for help and not getting anywhere, it's a bad relationship for me to be in.

That's why I'm not very encouraged by the entire process I've been through with the Atlanta VAMC in general-- I'm asking for help, I'm just getting shuffled around, when I have questions no one answers them. I'm just supposed to hold my tongue, just be patient, just wait and deal with it. Normally, I am still a pretty patient person-- I know I mention this often, but I worked at IT help desks for eight years, and if that's not credentials indicating patience I can't offer more. The response I get, especially at the last social worker appointment, is that people just do whatever they can to get rid of me and pass me on to the next person. I'm frankly tired of it, and it's making me feel worse instead of better.

So, because I want help, I will go to tomorrow's appointment. I will talk to the person. I will ask if I'm going to be leaving with a scheduled appointment for cognitive processing therapy, and if the answer's anything but yes I'm done with trying to get help from the Atlanta VAMC.

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