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Rafael M.T.Therapist
Rafael M.T.Therapist, Psychotherapist
Category: Mental Health
Satisfied Customers: 3189
Experience:  MHT-MHRS-MS-MA Integral Psychotherapist & Life Coach
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I had written to you earlier today, re my boyfriend who suffers

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I had written to you earlier today, re my boyfriend who suffers from chronic pain and depression. Unfortunately, not long after I replied to your last email, he came to my home and said he wanted to talk. I already anticipated that he would be ending the
relationship, but he could hardly speak - he was sobbing, apologizing and saying that he was ashamed and that "he was in a lot of trouble" I thought he was referring to his mental state, but just continued to sob and said he has become addicted to the Tramadol.
He is taking Effexor, Calonopin, and Ambien - plus the addition of tramadol as "needed" not to exceed 100 mg per week. He told me he has never felt worse - both emotionally and the physical pain. He said that it has now been 8 yrs of chronic pain and doesnt
see an end in sight. He does not use it to get "high" and recognizes that he has a problem and will tritrate down with his drs help, whom he sees tomorrow. He just said there are days he just needs it as the pain is so bad. He has had mini breakdowns before
- but this was worse than I have ever seen. He then talked about how unhappy he is, and how it is not fair to me, etc. I finally was able to get him to relax a bit and told him whatever choices he needs to make as far as our relationship are fine, but that
we are friends first and right now he needs a friend - I had no intention of leaving him alone. He calmed down once he was back in his own home, we ate dinner in bed and just watched TV as if nothing happened prior, although I have no idea what was going on
in his head, but he finally fell aslep and here I am, I dont know what to do next? I know he feels very ashamed of the choices he has made and while I believe he is forthright with his psychiatrist, I thInk he "downplays" his breakdowns and the frequencies
of same. He told me once that "therapy" never worked for him before, and I questioned how honest he was in his sessions. He is. Very, very intelligent 58 yr old man, and I believe that since he is so knowledable that he "fools" in some way his psychatrists,
tht he is not as unwell as he is. He made me promise not to tell anyone about the meds, but I don't know if I should just hope he speaks his psychiatrist or call him myself and tell him how concerned I am? I truly believe that perhaps a facility with a short
term 30 day rehab/ depression clinic could or should be n option. When I mentioned this - he said his dr told him he was "functioning" and that he doesn't need that type of care but again, I know him and I think he downplays his mini breakdowns but he needs
another type of help and I just do t know what I should do?? Please tell me what my next steps should be.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Rafael M.T.Therapist replied 1 year ago.

I am sorry to hear about his addiction to such drug, just as I feared and commented in previous message. As your story shows, here the core issues of denial, avoidance, repression, rationalization and more seems to be deeply undermining his ability to face reality, cope and take good care of himself. As you concurred, there is no way he could truly start and get well into his rehabilitation process from all these disorders, unless he acknowledge the seriousness of his situation, and takes full responsibility for his choices and actions, committing to work on himself with necessary Expert support. He requires what we know as dual diagnosis treatment, once he has an addiction problem plus depression, anxiety and for any other mental health problem he may suffer, including personality issues.It seems obvious to me that treatment should be intensive, and most times in scenarios like this, due to the addiction issues, inpatient programs rather than outpatient become the best and realistic option for him.He would have to get Expert support to get detoxified first, in order to be able to work on himself with regular psychotherapeutic support. It would be a multidisciplinary team of Experts who would assist him, but again, as explained before, without him coming to terms with the fact that he requires to work on himself at the mental and emotional levels, in order to take then consistent actions and literally transform his life style, he would not be able to get better, nor rehabilitate from any of these serious conditions. Your role would be of providing assertive support, of promoting his awareness of reality and accountability for his own process, confronting nay unhealthy or dysfunctional thinking pattern. Any person around him playing a codependent role would only fuel and enable his disorders and the illusions they create even more, thus such is the last approach you would like to have in this situation. Obviously being assertive would be something he would not like, he would negatively react, becoming defensive, and pushing you away, but that is a consequence you would have to afford if what you truly want is to be supportive and offer something healthy that could promote his awareness and responsibility. If he has nobody truly supporting him already, then you would be the only one bringing some light into reality in his life. Secrecy would be one more codependent pattern that would not help but deepen his dysfunctions. His request for you not to tell anybody about it shows he is not truly willing to start doing what he needs to do to start his rehabilitation process. This is very sad and frustrating but real. This is also a main reason why I said before that you need to assess what you are truly willing to afford or not in this situation, once the issues and challenges are many and very serious too. Finally, my suggestions are for him to get dual-diagnosis intensive inpatient treatment after completing detox program; then he would need to commit to an IOP - intensive outpatient program, followed by regular individual psychotherapy and attendance to adequate support groups. During intensive treatment he should receive individual, group and family psychotherapy for these treatments to be effective, once his dysfunctions-addictions are not isolated from reality, but part pf a whole reality where people around him have played in different ways, more or less codependent roles fueling his addiction-disorders. You can only be absolutely honest and open towards him, providing unconditional "healthy" affection and insight, without including any form of codependent influence, which is what he'd look for, since that would be the worst way not to support him, but to undermine his reality, fueling his illusions even more. You can and should only do what depends on you, as a fully responsible adult, while he needs to do the same, and nobody can or should try to do this for him.

Customer: replied 1 year ago.
Thank you Rafael. I completely understand. I am going to ask him if I can accompany him to his psychiatrist today. I am sure he will not allow/want me to do so, but as I had mentioned his low self esteem, feelings of embarrassment and shame which are constant in his life, lead me to believe he is not being forthright with his doctor. Is it crossing boundaries to ask to go? I would like to know that his doctor is aware, and additionally, see what plans are going to be implemented to move forward. And, if he will not allow me to go, should I call his doctor myself? i am aware that his doctor would not be able to comment and I also assume would tell him I had phoned.He is a wonderful man and is trapped in a cycle of chronic pain depression and now an addiction. I know that I cannot enable him, but will be strong and assist him in his recovery. I think he has a tough road ahead, but I can't turn my back on him as I know he would be there to support me as well. Thank you again for all your advice. I have a feeling I will be circling back to you.
Expert:  Rafael M.T.Therapist replied 1 year ago.
Yes, you are very clear about reality here, and I agree that what could happen is that he would refuse the idea of you going with him. if he does allow you to be there with him, it would show you he has truly change his main approach and decided to take responsibility and start his rehabilitation processes, but I am afraid it would not happen now, but hope he doesn't take too long for starting this process.
You have been partners for 3 years, thus I do not see how it could be something disrespectful or wrong to expect and ask him to consider, specially because it is about his very health, life and well-being, and also about he getting well in order to be able to have a new chance to continue building your relationship as he gets better, what is the very reason he used to end the relationship, to work on his rehabilitation.
Now if he does not allow you to go, you would have to assess the pros and cons of crossing this new boundary about directly contacting his psychiatrist. You have the right to openly discuss this matter about going with him to his appointment, but not of contacting his doctor, and he would obviously react very negatively to that, which would deeply impact the friendship or any type of relationship you may have now and in the future. But again, you would have to assess what you are willing to afford here. As you said, his doctor could just listen what you have to say without acknowledging even knowing him, and that's how we keep confidentiality in this filed, while becoming aware of serious issues deeply undermining treatment or a client's well-being. But this actions do use to trigger serious problems in the relationships. His doctor could immediately stop refilling the pain medication, and he could also change psychiatrist just to get it without having to afford facing reality having the doctor very aware of his addiction. It would all depend on how truly honest and accountable he chooses to be from now on.
Please reflect on what you truly want and are willing to afford here,setting your priorities and taking consistent actions. You know him, his fears, personality and patterns; use such knowledge and understanding to support him in healthy ways as much as possible while taking good care of yourself, reminding yourself that every assertive step you take to support him, would usually trigger a negative reaction from him, while any codependent approach would be taken as something nice and for for him, while you know it would not truly help, but only enable his addiction and self-sabotage.
Thank you for your trust. it is a tough situation the one you are facing, but it would offer significant and powerful lessons that could transform you for good, making you wiser, stronger, more resilient too. It implies a lot of pain, but it's part of your path, and you need to work on it as good as possible, with adequate support too.
Take gentle care.
Rafael M.T.Therapist, Psychotherapist
Category: Mental Health
Satisfied Customers: 3189
Experience: MHT-MHRS-MS-MA Integral Psychotherapist & Life Coach
Rafael M.T.Therapist and other Mental Health Specialists are ready to help you

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