The importance of a good therapeutic relationship

Been chatting via SMS with one of the little super heros psychologists. I can see the clock,  she is in her own time. Giving each other a small pat on the back, she has become a good friend,  as we make our way further towards discharge and it looks more and more like we have somehow navigated the most high risk stage of pediatric bipolar without catastrophe. 

The world hasn’t imploded. She hasn’t been hospitalised which is nigh unheard of and she is stable. High school is looking doable and teachers are keeping an eye out for trouble. 

Not only is her diagnosis rare occurring in only 0.5% of the population. Her response to treatment and incredible progress is found in only 20% of that 0.5%

With recently having to change GP due to ours moving closer to the city the discussion turned to how well her recommendation is travelling. I had lost count of the number of times that portly Egyptian had saved my life and the lives of family members over the years. Without him we wouldn’t have made it this far. So far it is too early to tell for his replacement, but it looks promising in spite of the expected hurdles and bumps of losing a fantastic relationship and friendship which had keep me out of hospitals for the better part of the last decade. 

It can take a lifetime of being chewed up pushed bullied and spoken down to by various specialists and medical professionals for a patient to learn how valuable a good therapeutic relationship is. Some can go a lifetime without ever finding one. 

I have mentioned previously about the importance of not allowing doctors to rush to prescribe. But to do your homework before you agree to a given treatment and make sure that the diagnosis fits the bill, and if it doesn’t,  explain how it doesn’t,  engaging your doctor in discussion. 

If you cannot question your doctor,  with certainty it is not a good therapeutic relationship. It is equally important that you understand what treatments you are undertaking and why, along with what the expected outcomes should be in order to be able to convey if they were achieved. 

We know why things have gone as well as they have. We know what has made all the difference because we have experienced the complete opposite for their step father; A history of rushed prescribing, professionals not taking the time to diagnose, even using prescribing to diagnose as a short cut of the process and causing his condition to become more acute in the long term as a result. 

For the little super hero and her sisters in contrast; they listened, diagnosis took anywhere from months to years, prescribing was optional, we were allowed and even encouraged to question and challenge recommendations, I was encouraged to maintain contact outside of consultations,  to update them on how things are travelling,  even with them contacting me to determine the urgency of the next appointment. 

We have a healthy therapeutic relationship with her professionals without ego’s getting in the way. Blame and shame have no place in this relationship we all work together. 

It was only through my experience caring for bruce and my mother that I learned how important such a relationship is. It was only with that knowledge that I walked into consultations for my daughters equipped to work as a team with her professionals. I am also a professional in the way that I am the person who knows my daughters almost as well as they know themselves,  having spent their whole lives living with them and interacting,  having the knowledge necessary on which they can diagnose. I am an expert on my daughters. Most respected that. 

That’s not to say all did,  there were pediatricians GP’s and others who tried to push, to prescribe without a diagnostic process. I had the confidence and knowledge necessary to say no. 

I have the experience of dealing with psychosis and suicidal ideation to know that this we can deal with. Right now things are dark but rushing can make things so much darker. It may take weeks to months of them sitting at the bottom of a pit. But putting in the weeks to months now can save us months to years of misdiagnosis and treatments which can actually make their condition worse from now on even with corrections. 

I pray regularly that the mental health profession would more widely recognise this simple fact that is drilled into them throughout their studies, far too often friends and family fall into the hole of misdiagnosis. Recovery and good management IS possible from the start.  It is in those first months that the tone for relationships with mental health professionals and treatments is set. The last thing we want to do is cause patients so much trauma from the process of obtaining help that they don’t come forward and instead battle their disorder alone. 

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