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Old 15-05-2017, 10:32 PM   #61
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They're sticking with the recommendation of inpatient/residential. I'm literally begging them to let me give day treatment a shot. But I'm pretty sure they're going to say no.

I'm not doing it. This fucking sucks. I guess I'm losing my therapist now too.



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Old 16-05-2017, 02:27 AM   #62
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My therapist sent me this and I am unsure what to do. I do not think it is reasonable, a lot of it is entirely new and not things I've EVER had to do before, and well. I don't know. Some of it is literally not feasible for logistic reasons. (HB is the place I am going for HRT)

I'll self report because it does have a food list, but it's a meal plan thing given to me by a professional so I am pretty sure that makes it allowed.

The following content has been hidden - Reason : long
If you want a chance to prove yourself, I can't make the -- admit you into an inappropriate level of care. But, I can tell you what you need to do for me, at this time, in this moment, to get from now until June 9th, and what you will have to do after June 9th. These are non-negotiable terms. This is it. Take it or leave it. If you're motivated, you'll see that these terms are reasonable. According to the terms of our treatment, I am notifying you now about treatment interfering behavior, and telling you that this is what you have to do to remain in my care. These terms are your chance to improve your behavior and remain in my care.

Between now and June 9th, you would have to:
1) Eat according to our agreed plan. You can eat more and any other things you want, but you cannot eat less, and you cannot substitute any of the items on this plan.
2) Send me pictures of your meals when you're eating them. I know you hated this rule at ---, but I have to be able to see that you're eating.
3) No laxative use. None.
4) At your PCP visit on 6/7/17 (per your chart), you have to let them weigh you and get your height. I need these documented in your chart as part of your visit.

On June 9th:
1) At your HB appointment, you will be honest and forthcoming with them about your eating status.
2) You will bring a release of information form that we complete together with you to the appointment so that I can collaborate with your care providers there.
3) You will abide by all of their recommendations, including any recommendations for routine bloodwork and about treating your ED.

Within 2 weeks of your HB appointment:
1) You will reinitiate contact with the --- to identify the proper level of care for your ED. You indicated you would be willing to do this once you have your HB appointment.
2) If you decline their recommendation at that time, you will be discharged from my care.

This is your absolute last chance. If you cannot agree to these terms, I will have to refer you to other community based trans*/genderqueer/non-binary supportive resources. This is a zero tolerance policy. Any deviation from the terms I identified above will result in immediate termination from my care with referral to community resources. You need to think very, very carefully about whether or not you can honor these terms. If you say yes to this, it all starts tomorrow and I can't state clearly enough that this is it. So think long and hard. Talk to Logan or forward them my e-mail if you like. Again, there is no negotiating. This is it.

Let me know your answer. If I don't hear from you by the close of business tomorrow (5:00), I will assume your answer is no, and I will move forward with gathering resources for referrals and our session on Thursday will be our final visit.


Last edited by Aardbei : 31-05-2017 at 09:34 PM. Reason: Removed food list


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Old 16-05-2017, 10:14 AM   #63
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Whether you think it sounds reasonable or not (I personally don't see a problem with it) you need to show her you are going to fully work with her, not just bits on your terms.

And it doesn't sound like she is going to budge on this, and probably for very good reason.

New things can be incredibly scary in the short term, I can totally understand that. But nothing on that list is going to harm you. Yes you may have very uncomfortable feelings, but feelings cannot hurt you.

What are the logistically problems, you see? Maybe we can help you work around them.



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Old 16-05-2017, 11:43 AM   #64
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What are the logistical reasons for you not to be able to comply with this?

I agree with wonderland that she is very unlikely going to change her mind/have room for manouver so you are going to have to think carefully about this.

A few things I would probably think about are:

Is your therapist good in general and do you find her helpful?
What are the other services she will refer you too IF you decide not to comply? Are they good? Can you afford it? etc.



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Old 16-05-2017, 09:02 PM   #65
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sounds a bit harsh to me. but i'm not a therapist





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Old 16-05-2017, 09:20 PM   #66
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Quote:
Originally Posted by Wonderland. View Post
Whether you think it sounds reasonable or not (I personally don't see a problem with it) you need to show her you are going to fully work with her, not just bits on your terms.

And it doesn't sound like she is going to budge on this, and probably for very good reason.

New things can be incredibly scary in the short term, I can totally understand that. But nothing on that list is going to harm you. Yes you may have very uncomfortable feelings, but feelings cannot hurt you.

What are the logistically problems, you see? Maybe we can help you work around them.
This basically.



'Never forget what you are. The rest of the world will not. Wear it like armor, and it can never be used to hurt you.'

['There is only one thing we say to death. Not today'.']

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ĎItís hard to dance with the devil on your back.í Sydney Carter


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Old 16-05-2017, 10:14 PM   #67
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I explained some of them to her and she changed it slightly.

If I fuck it up, she kicks me out.
If I did not agree, she kicks me out.

So my coworker said I had nothing to lose, so to go ahead and agree. I am honestly unsure if I can do it.


Is your therapist good in general and do you find her helpful?
Yes. Very much so. She is the only therapist I have ever found that actually seems to get me, and seems to think she can help.

What are the other services she will refer you too IF you decide not to comply? Are they good? Can you afford it? etc.
Unsure. It's likely a place where I've been for therapy before that had no understanding of eating disorders, and did not find very helpful at all. Unless the services are free, it's unlikely I'd be able to afford much else.



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Old 16-05-2017, 10:25 PM   #68
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I think you friend makes a good point. It does sound like the best course of action is to agree as it keeps options open.

A well nourished body is so important especially when you are asking it to go through changes. Do you think you could reframe what she is asking as things to do to enable you to move forward rather than things that if you don't do moving forward will be more difficult? (I appreciate this is a subtle difference but it's something I can find helpful)



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Old 16-05-2017, 11:08 PM   #69
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I am unsure. I think maybe once I get hormones and maybe things start to change yes I could see it that way. But right now it is too hard.



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Old 16-05-2017, 11:20 PM   #70
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If she's helpful and the alternative options are awful then agreeing to it is surely a sensible thing? Rather than self sabotaging and losing a good therapist and getting more mentally unwell?



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Old 16-05-2017, 11:46 PM   #71
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Yes, but I am just unsure I can actually do it.



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Old 17-05-2017, 09:25 AM   #72
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Quote:
Originally Posted by Auror. View Post
Yes, but I am just unsure I can actually do it.
Can you break down the specific bits that you are most worried about, and maybe we can give some suggestions?

As you said ultimately if you don't agree you'll lose C and if you don't succeed you'll lose her--at least this way (agreeing and trying it), you are giving yourself a better chance.

EDIT for further thoughts:

Has anyone actually told you or provided information as to why it's so important that you're medically stable before starting HRT? If not, is this something you could ask for? I think that having concrete reasons which are likely medical might help you.


Last edited by Dreamer And Believer : 17-05-2017 at 09:28 AM. Reason: adding info
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Old 17-05-2017, 12:59 PM   #73
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what bits do you think you will struggle with?

I agree with Dreamer that you're better off agreeing to try it as it gives you a better chance..and that way, If/when you struggle with it, you've still got her support? I'm sure she doesn't think that if you agree it will all be really easy. Although there is no room for manouver she could support you in doing some of those things?



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Old 17-05-2017, 06:34 PM   #74
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I don't really have her support though. I can't say that I'm struggling. Because either I do the things regardless or I don't and I get kicked out. That's not therapy.

I'm worried about having to eat that much.
I'm worried about having food in me.
I'm worried about not being allowed to take laxatives.
I'm worried about body parts getting larger if this makes me gain weight.

I don't know if I even want to do this, much less if I can. Nobody thinks I can.

I donít want ed treatment. I donít want to eat more. I donít want food in me. I donít want body parts to get larger and thus I donít want to gain weight. Iíve been managing how things are. I canít deal with this body as is. I think it should be my choice and I donít understand why itís so wrong to not want to go back to treatment.

That doesnít mean I donít want therapy or help. It just means I donít want eating to be the focus of it, because thatís not the important thing I need help dealing with. And clearly nobody is understanding that which is pissing me off.

As far as HRT, nobody's said much. They said that typically they want you to be medically stable for it, but that stability is defined by the provider you see. So nobody can really say anything more. My friend says because it is a controlled substance and technically a steroid they have to make sure it is safe for you to take.



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Old 17-05-2017, 07:47 PM   #75
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hmm but if you were doing those things so you were eating what you needed to eat you could say "look i'm doing X but I still feel Y and can I have help with those feelings/thoughts tide into it"

Your friend speaks truth about the HRT and it also effects you a lot emotionally too. steroids can really mess with your brain.

I understand that it should be your decision re treatment but if you get super unwell or worse they will be held responsible for not making sure you got the correct care.



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Old 17-05-2017, 08:17 PM   #76
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Thinking of you . I agree with what these guys have said and being scared is understandable. Can you explain to her what you are afraid of? Could you view as a stepping stone as HopeRises suggests? Xx

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Old 17-05-2017, 09:47 PM   #77
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She knows the thoughts and feelings that are tied into what she is asking of me, because I've been telling her for months. Transitioning and HRT will help, and those are the things that are going to help the most mentally. Physically there's not really much anyone can do.

She's said the same about all of this- that she's doing it because she cares and she can't just sit back and do nothing when things are so serious because it could legit kill me or something. Which is not true.



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Old 18-05-2017, 12:38 AM   #78
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This is too much. I kind of think I might be better off being dead. But I would be dead in this body. Fuck. Fuck fuck fuck.



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Old 18-05-2017, 05:34 AM   #79
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*sits with*
I'm sorry things are so difficult just now. I can promise you are better alive. Things are rubbish just now, but that is temporary. We need you here!

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Old 18-05-2017, 10:41 AM   #80
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It 100% makes sense the connection between eating, weight gain, and body image. I'm going to put the next bit under a hide box because it talks about specific gender-related body parts/issues and weight-- up to you whether you feel safe reading it.

The following content has been hidden - Reason : Possible triggers


In a biologically female body the breasts are one of the first areas to gain/lose weight as it's where we hold a lot of fat tissue so I imagine that your fear is that gaining weight will make you look more feminine, which is the last thing you want.

That said from what I know about hormones and transitioning--I knew someone transitioning male-to-female and she was encouraged to lose weight before and during the transition process. This is because she was overweight and they told her that part of the MTF transition is redistribution of body fat to more feminine areas (breasts, hips etc) but this wouldn't be very visible or effective at her weight.

If you think of it in reverse, taking testosterone will cause redistribution of fatty tissue/weight in a more masculine way. Therefore if you are already at a low weight/underweight there may be the risk that it reduces your weight even more to a level that's even more unsafe. As much as you need to transition to feel safe and healthy in the body you're in, I don't think you want to damage your body in the process.


I hear what you're saying about feeling ignored, not listened to, and forced into things you're not comfortable with, and as much as I have encouraged you to go down the route of the therapy agreement, I get where you're coming from. But the professionals working with you have to abide by certain rules and requirements to make sure that you are safe and that they don't support you in ways that could cause you harm. Unfortunately what that means medically speaking doesn't always line up with respecting your rights and choices as an individual and that's shitty, but ultimately sometimes we have to make compromises to work within the system we're in to get to our long-term goals.

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