How can I feel comfortable with my psychiatrist again?

• My psychiatrist lost his temper with me on the phone yesterday and said a lot of hurtful things. I must have deserved them, but I feel terrible. I have an appointment with him tomorrow (7/2) at 8am EST I need help figuring out how to keep my cool and understand how to be both a better patient and a better person.I apologize in advance for how incredibly long this is, and thanks in advance for those of you who read it. I have a long-standing (~4 year) relationship with my psychiatrist, to whom I am forever grateful for pulling me out of a deep, prolonged suicidal depression in 2012. He took care of me and for a long time and was very understanding, patient, and seemed genuinely pleased to have me as a patient. I have also consistently been in talk therapy during this time, also within his practice (but not with him, rather with various therapists that report to him.) I have a very long history of MDD and GAD, since I was about 14 years old. This psychiatrist also diagnosed me with Borderline Personality Disorder in the last year, though he said I only exhibit certain traits of it (mood lability, abandonment issues) and not others (impulsivity, splitting, manipulation). This is just for your background understanding of who I am. I see a separate therapist entirely at a different practice for DBT skills treatment for the BPD. In the past couple of years, I have realized through trial and error, trauma, and extensive research (without his help, but with his understanding and support) that I have serious hormonal issues that make me sensitive to many types of birth control that have a very specific kind of progestin, and this has exacerbated my mental health issues severely. I will not go too far down that rabbit hole here, but the short(ish) of it is that in the past 3 years of being on countless birth control methods (and sometimes none at all), I've realized that certain types make me profoundly suicidal. One of these is Nexplanon, which I had to have removed recently after another 3 month ordeal with deep suicidal depression. I will be getting a tubal ligation soon, but had to go back on birth control pills in the meantime (one of the traumas I experienced recently is pregnancy and abortion, so I want to be as cautious as possible). I want to interject here and explain that during this last 3-month bout of suicidal depression, the one that ended with the Nexplanon removal, my pharmacy mistakenly gave me half of my prescription of Klonopin. I didn't notice until it was too late unfortunately, and since it's the type of drug that people abuse, I had to contact my psych for assistance. While he did call a new script in, he assumed that I had been taking more (I wasn't -- I keep strict tabs on my medication intake), and cut me off any time I tried to explain otherwise, saying that it was irrelevant and he didn't have time or energy to listen to me. I didn't feel comfortable seeing him after that. I haven't gone in since, but have continued my talk therapy. Back to the story. My gynecologist noticed that I was taking a mood stabilizer that interferes with the efficacy of my new birth control and told me to stop taking it immediately, and to contact my psychiatrist right away so I could get on a different mood stabilizer. I called the office to make an appointment with my psych, but he didn't have one available for over a week. Knowing that it would not be healthy for me to discontinue mood stabilizers for so long, I left him a voicemail explaining the situation and asking if he could call in my old mood stabilizers (that don't interact with my birth control) while I wait to see him in person. He didn't return my call. I left 2 more voicemails over the course of the next 3 days, and at this point my mood was plummeting as I felt the results of discontinuing a needed medication. I finally called my therapist and asked if she could speak to him, since I wasn't sure why he wasn't getting back to me. He finally called me back. He seemed very angry. I admit that I was crying throughout the call (quietly, but still, really horrible form on my part, but I can't control my tears). He told me he'd heard my voicemails, but had no intention of returning my calls because he saw I had an appointment with him scheduled and he didn't see any reason why my request was urgent or important. "I don't remember ever telling you to discontinue your mood stabilizer." I explained again that my gynecologist told me to discontinue immediately. He sighed and looked up my new birth control, declared that my gynecologist was wrong, and told me to continue taking the medication. He admonished me for making phone calls instead of coming in (again, I took the first available appointment, which isn't until tomorrow). He then asked me why I hadn't been coming. I explained that I was uncomfortable and scared to come in to see him. I told him that he was clearly very angry with me. He said he was definitely frustrated with me (he didn't explain why), but certainly not angry. I also said that I was scared to come in after the way he'd handled the Klonopin issue. He told me that I was projecting, and that it hadn't registered for him as an issue. "We will never know how that medication got lost," he said. And then I made a really horrible mistake. I said (and admittedly I said it very calmly, but still, it was just so horrible of me to say): "Doctor, the medication wasn't lost." And then he began to yell at me. "You know what, timory? I told you I wasn't angry and you don't believe me. I don't have the time or desire to deal with you or your problems. I'm not going to sit here and give you therapy and listen to your problems when all of your pathologies about abandonment and fear of criticism are coming out right here on the phone. You are being completely ridiculous!" Then I made my second huge mistake and (still crying, I seriously have a problem controlling my tears, and I know that is a MAJOR failing of mine) told him, also quietly but I was making an idiotic attempt to stand up for myself, that I felt even more uncomfortable seeing him after hearing him say that. He said, "are you seriously telling me that you want to end our therapy relationship right now?" I stammered and said no, no, I don't know what I want. "I'm just really not well," I said. "No, you're not!" he screamed. "And you called me ridiculous, so..." but he interrupted me and said "Yeah, you ARE being ridiculous!" I was at a total loss. I apologized profusely, and he said "apology accepted" very curtly. I told him I'd be in for my appointment. He repeated that he really thought I was "better than this" and that discussions like this need to happen in person, which is absolutely true. This man is a professional and I trust him, and I want to please him. Making sure that he is happy with me is more important to me than my well-being. I am trying to understand sincerely what I have done wrong, and to tamp down the parts of me that are saying "it's not okay for him to treat mw like this." Things to consider: I'm an unreliable narrator. Since having the Nexplanon removed, the suicidality lifted almost immediately. However, my life circumstances right now are not particularly good, and I am not in a great place in general. I haven't slept more than a few hours a night for about two weeks (I'm one of those weenies who needs 8-9 hours/night to be functional). I am prone to exaggeration and hyperbole. I had been crying throughout the phone call, so perhaps he believed that I was manipulating him. Perhaps my account here is completely inaccurate, as well? I have tried to present this objectively, but I know that my pathologies prevent that from being possible. Here is how I'm trying to handle things, but I need more help: He is only human, and I must have behaved ridiculously. I should have realized that it was totally ridiculous to have such a fear of pregnancy that I'm uncomfortable having sex with both birth control and a condom if the BC's efficacy is lowered by a mood stabilizer. I should never have stopped taking the mood stabilizer just because my gyno told me to. I should just have abstained from sex altogether until my psych was able to see me in person and never have left him any voicemails at all. Then all of this could have been avoided. It was in no way an emergency and calling him AND my therapist was outrageous, and he was more than justified in his frustration and outburst. His methods of ignoring telephone calls may simply be a form of training me to realize that my behavior is unacceptable. Yelling at me might be a form of tough love. He knows that I have extremely deep-seated self-hatred and that I put other people's needs before mine, so while every fiber of my being is screaming "everything he said makes me hate myself more!", I know he either did it out of tough love or just because I had really tested his patience so much with my abhorrent behavior that he just couldn't take it anymore. Any advice is extremely appreciated. I see him tomorrow at 8am, and I am panicking so much that I can focus on nothing else. I am trying to meditate and use the skills I've learned in DBT, but I'm really struggling.

• Answer:

  You're right. I'm really prone to exaggeration and hyperbole. I think I am highly likely doing that here and just writing all of this to get sympathy and incite the kind of responses I'm getting here. I'm sure that he was being totally reasonable. I'm trying to regulate myself emotionally, and I shouldn't have said that. I apologize. Everything you write here sounds like me, and the reason I do it is because I struggle with a balanced understanding of the world, although it is much better since I had a couple of years of really good therapy. For me, it was about a really fragile sense of self - if I wasn't perfect, then I was worthless, and the only thing that could restore any kind of "worth" for me was the most abject "I was 100% wrong, here is why" apology. Saying "yes, I made a mistake but there were some other things in play and really the sun will still rise tomorrow" was just about impossible for me. I don't know what's going on with you, but I hear a lot of abjection in these comments. Your therapist could be a sympathetic human being and a sterling fellow who none the less treated you really badly. You could be needy and whiny and still not deserve to be yelled at on the phone. Also, it's okay to want sympathy. People without any diagnosed issue at all can be slightly unreliable narrators who play for sympathy a bit; to me, that's part of talking through something bad that's happened. It's okay to want some reassurance or to feel a little self-pity. Now, you may not be at all like me, but your writing reminds me of me: I would get in this state where I would lurch back and forth between wanting sympathy and wanting to hate myself for wanting sympathy, where I would let myself into situations where I would be treated really badly (not because I deserved it! but because there are bad people out there and I had a habit of not setting boundaries because I didn't know how and being emotionally abused was familiar). I would find myself in situations again and again where I was "bad" and I had to abjectly apologize, and only after I was in this state of abjection did I feel okay about myself - only after I had "confessed" as you did here that I probably was just making it up, it was probably all my fault, etc. This was because I had grown up feeling like I was bad and inadequate in every way and the only way I felt at home in the world was when I could put myself in situations where I would be treated as inferior and wrong. For me, I found a really compassionate therapist (I was very, very lucky). I basically talked to him for two years (and then he was hired away to train others, he was that good....) and now I have internalized his voice - I have a tiny therapist inside my brain, and when I get into this "I am a bad person and I have to get everyone to recognize how bad I am" state, I can listen to the tiny therapist who talks me down and exercises compassion. This psychiatrist - and I know he's only the prescribing guy - does not sound compassionate.