The Means of Addressing Negative Emotions Experienced During Psychiatric Treatment: Insights from a Psychotherapeutic Process

In the socio-cultural context I find myself embedded in, reaching out for support and seeking mental health services is a courageous first step. However, an aspect of receiving support that tends to take up less space in discussions pertains to issues that many individuals may encounter during the course of psychiatric treatment itself.

I have firsthand experience with the many barriers that exist in psychiatric treatment after receiving a bipolar II diagnosis nearly seven years ago and having gone through the incredibly frustrating process of learning the most effective treatment and medication regime. The frustration did not stem from the stigma I experienced, but moreso from the rigorous process of finding the appropriate medication. While studies have investigated the phenomenon of non-adherence to psychiatric medications, there is limited research on medication adherence throughout the process of discovering the most efficient dose and brand of medication for each individual (Semahegn et al., 2020). Rottman and colleagues (2016) proposed that when an individual starts taking medication, they begin to analyze the causal effects it has, particularly in terms of its perceived effectiveness. In my experience, when beneficial effects were not observed early on, a sense of distress and spiraling negative emotions overwhelmed me. Psychotherapy can and should play an impactful role during this phase of treatment by helping the individual explore and process the feelings of frustration, anger, despair, and hopelessness that are often present. This article seeks to elaborate on how psychotherapy served as a way to help me cope with each of these emotions and may in turn serve as an important reminder for practitioners to support patients who are experiencing similar issues.

According to Dollard and colleagues (1939), frustration is “an interference with the occurrence of an instigated goal-response at its proper time in the behaviour sequence” (p. 7). Further, the frustration-aggression hypothesis proposes that anger can also be an associated emotion that results from the frustration experienced at certain goals being blocked or deemed unachievable (Miller, 1941). Frustration as a state tends to be experienced when there is an intent to gratify or obtain access to a state that is desired; therefore, without intent or an inherent expectation, there can be no frustration (Dollard et al., 1939). During the process of seeking psychiatric treatment, my initial goal was to escape from my symptoms and achieve gratification in the form of relief, respite, and a return to a premorbid state of functioning. When this goal was perceived as unachievable due to an ineffective dosage or combination of medications, it often resulted in feelings of increased frustration and anger expressed through crying spells, irritated behaviour, and a reduced desire to comply with psychiatric treatment. It was through psychotherapy that I learned to modify and reframe my individual treatment goals, which was immensely helpful to overcome the state of frustration-aggression that I was experiencing. My initial thought transformed from, “medication is not helping me feel better” to “I am doing everything I can to help myself feel better.” This shift in perspective effectively decreased my sense of frustration as it allowed me to concentrate on behaviours that were in my control; such as, complying with psychotherapeutic treatment, adhering to medication instructions, and voicing any concerns that presented to my treatment team. I was no longer focused on being cured after realizing the value of the recovery process. As a result, I experienced an enhanced sense of autonomy and control over my journey.

In addition to feelings of frustration and aggression, I was plagued by a sense of hopelessness. Hopelessness refers to a state of being in which the individual experiences a loss of the expectation that outcomes will improve (Abramson et al., 1993). Research highlights that feelings of hopelessness are often compounded by a sense of despair where the person feels helpless to cure the self of deep emotional pain and suffering (Jeanne, 2015). In my experience with therapy, when results were not felt as I expected, there was a great sense of hopelessness and despair in my treatment journey. I convinced myself that regardless of the attempts made or the various combinations of medications I tried, my condition was doomed to remain in a static state. This was further compounded by knowing that bipolar II disorder tends to be a chronic illness with a poor prognosis (Tundo et al., 2013). Consequently, my feelings of hopelessness and despair reached to the point where I made an attempt on my life due to the belief that I would never improve or feel better. I ultimately overcame this ideation after receiving an incredible amount of support from my family and by pushing myself to persist in treatment.

Through psychotherapy, I discovered important insights that allowed me to tackle and eventually deal with the feelings of hopelessness and despair that were often present. The first insight pertained to challenging my primary cognitive distortion of predicting the future. I realized that no matter how hard I tried, I could not guarantee that any combination of medications would help with my condition, at least not before trying all of them. Instead of believing that my condition would never get better, I was led to believe that I was absolutely on the right track to figuring out which medications would eventually work well for me. The second thing that proved insightful was my therapist’s strengths-based approach. This allowed me to focus on my strengths and gave me the ability to regulate my emotions and functioning, regardless of the medication I was using. This approach was empowering as it served to highlight my strengths and reduced my perceived dependency on pharmacotherapeutic intervention. This is an important aspect to psychiatric intervention, as research demonstrates that psychotherapeutic treatments promoting medication adherence can be particularly useful for states of mania and hypomania, while cognitive coping strategies have a more pronounced benefit when it comes to depressive episodes (Miklowitz, 2008). An amalgamation of challenging faulty cognitions, adopting a perspective where I focused on the small wins and not just failures, and taking a comprehensive overview of my role in the situation helped me address the blocks and sense of hopelessness and despair I encountered.

While it is a well-established fact that psychotherapy is often a crucial aspect of treatment for a mental illness combined with psychiatric intervention, sometimes psychotherapeutic services may be required to overcome barriers and distress associated with psychiatric interventions themselves (Gabbard, 2009). Through the use of various cognitive and strength-based approaches, I was able to work on and process my frustration and hopelessness associated with having to try combinations of medications to keep my symptoms under control. The process, even though distressing at times, is a crucial aspect of learning how to live with and manage a chronic psychiatric illness.

The issues discussed above need to be further addressed in the field of research and should be highlighted as a legitimate concern that patients may often go through, so that more evidence-based interventions may be formulated and used for the same purpose. In terms of implications for practitioners, this article seeks to shed light on and open up a dialogue about the negative emotions that individuals may experience whilst engaging in psychiatric treatment for mental health disorders. In the case of chronic mental illness, it is essential for individuals to comply with treatment and when the process of using medication is perceived as distressing, this may result in non-adherence. Practitioners may benefit from discussing this potential obstacle with patients and to be prepared to implement techniques and interventions to support patients experiencing this type of distress. Furthermore, addressing such an issue can also help challenge the myth that pharmacotherapy is unhelpful for mental health disorders as this may be believed by various individuals, including patients (Kishore et al., 2011). This has the potential to have a profoundly positive impact on psychiatrists, mental health professionals, psychotherapists, and patients themselves.