A Severely Disturbed Patient

My therapist wrote an article together with a colleague, which was recently published as part of an anthology / publisher’s edition on psychiatric disorders and different treatment approaches. I have reason to believe that I am featuring as a case example in it: of course, everything is anonymized and no personal information is given other than that the patient is female, but there’s nothing in the case example which doesn’t match my diagnosis and specific problems, so unless he has another patient who is very, very similar to me, there’s no doubt about that.
I can’t quote the article or example here because it would reveal my therapist’s name and location, but the “severely disturbed” patient with double depression is described as emotionally distant (meaning the patient expresses no emotions towards the clinician) and detached (i.e. making no emotional connection to the clinician in order to deal with anxiety that’s triggered by other people), as well as exhibiting behaviour predominated by submissive characteristics. Interpersonal avoidance is cited as well as social fear. All of this could still be coincidence, but what makes me as certain as I can be without actually asking him is that the case example features “rules” describing my (pre-treatment) behaviour which we worked out in the beginning of therapy. Detached or submissive behaviour are part of the standard features for chronic depression and could be detected in quite a number of patients, but those rules were personal….

I have nothing against this – quite the opposite. When I signed up for the programme, I knew my data would be used and I knew they were doing clinical research even when I first picked the hospital as a possible treatment facility. I gave blood for a worldwide clinical research project which tests how genetic factors influence the efficacy of antidepressants, so that in the future psychoactive drugs can be tailored to measure the patient’s individual genetic disposition – since citalopram caused a lot of side-effects for me and left much to be desired, chances are that I am someone whose response to such medication is rather poor due to genetic reasons. Actually, before I started therapy and was completely ruled by depressive thinking still, I thought by myself, “You’ll probably never manage to get a university degree and do scientific research, so it would be cool to contribute your part to science as a ‘test subject’ instead.”
However, I’m uncertain whether to flat-out ask my therapist about it or not. It’s not like the article is a secret project; he links to it under his profile on the hospital website and the full text is accessible for reading. The reason I read it in the first place is because he told me about the results of an US-American clinical trial cited in the article and I was simply curious about it and wanted to know more details. So I started reading and after a couple of pages suddenly saw myself confronted with a very familiar case example.
Given the date of publication, he must have written the text early this year; it quotes other works from 2011. So it is very well possible that this is indeed my case, and I would understand why he didn’t mention it to me then, because quite frankly I might have felt even more “defective” than I already did. CBASP works under the premise that chronically depressed patients are stuck or get set back to an earlier developmental stage of thinking because of adverse conditions they endure repeatedly or over very long periods of time, and when I first learned about this in therapy, I felt ashamed for “having an immature brain”. So, had I read phrases like “severely disturbed patient” about myself back then, it would indeed have caused me distress. These days I can look at it and accept it for what it is, though. I wouldn’t have ended up in therapy had it been any different – or at least not in this programme – and my therapist gently gave me feedback on behaviour that made me figure out my deficits over time without being crushed by the realization.
I’d like to have certainty about this. One can only change if aware of what’s wrong with oneself, and over the last year I have often been in situations where I had to realize that my own perception of myself differed quite fundamentally from the feedback I received from others. If anything, the knowledge that this is indeed a professional description of my condition would be an additional source of feedback, because here nothing is sugar-coated. And if I’m a case example in a book on psychiatric disorders, I want to know, out of sheer curiosity alone – which means I’ll have to write him an email.

Update:
After bringing up the courage to ask him, I received a very nice email back, explaining that this was actually written in 2009 already, but published only now. The case example is based on a CBASP patient from “long ago” and it’s pure coincidence, “even though you’ll certainly find yourself in that too.”
So apparently there’s a former patient who had made up the same rule for herself – because there’s no reason I shouldn’t believe my therapist. He wouldn’t lie to me about that.

All of this made me think about how, even though I know my therapist has treated and still treats quite a number of other patients with CBASP, I have never met anyone else – neither personally nor online – who was diagnosed with chronic depression and did a CBASP therapy.

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