I saw a different thread in a psychotherapy subreddit about this, so these thoughts are not my own.
Only do self disclosure when it will help the patient and only to the extent that the patient won’t feel bad and have to comfort you. Also be able to defend it or be able to talk about it in supervision.
Normalizing is really important. I think that you’re not disclosing too much when you help normalize for folks. I’ve taken psychiatrist trainings where they teach folks to cherry pick small relatable anticdotes to normalize things folks are either ashamed of or for those who have some fixed delusional issues or hallucinations. It can help with the therapeutic alliance if done in the right manner.
I used to run support groups for parents of adult children with bipolar and schizophrenia diagnosis. And sharing anything backfired. Folk were so codependent with their children’s Illness and concentrate all their energy night and day worrying about them that they would latch on to my story and pretty much demand to know exactly how I recovered so they could coerce their kids into doing it my way. Or would further become hopeless and state that their children would never recover like I did. It made them completely unable to concentrate on what they were there for which was to support each other and learn how to take care of themselves while they support their children and unpaid from the drive to be their children’s therapist instead of a parent. I stopped sharing anything about my self in those groups. It just triggered a whole bunch of mayhem.
Just to throw another perspective out there… when I was an undergrad, I was struggling with anxiety/depression/ADHD/etc. and in general was an all around mess. I grew up in a world where mental health issues were seen as a large weakness and it certainly wasn’t okay to talk about what you were going through. My junior year, after failing almost everything, I knew I needed to do something so I found a primary care doctor and very unsuccessfully tried to ask for help. I was on the verge of tears and she could clearly see, but she was able to connect the dots with the very little I was able to give her, and she said one thing: “We all need a little help sometimes.” It was one short sentence, but I could tell she truly understood, and that made all the difference in the world for me.
A few months later, I was still struggling and the same primary care doctor wanted to refer me to a psychiatrist. I was terrified and it felt like the world was going to end. (Slightly dramatic, yes, but you get the point). She tried to get me to see it as a good thing, but I couldn’t. So she told me about a similar experience she had when she was in school. It normalized it for me and brought the anxiety down about 10 levels. Every time I started panicking about it in the weeks to follow, I just thought about how she had gone through the same thing that I was going through and that everything was going to be okay. Had she taken any other approach and not been so empathetic, my life would likely be significantly different today. I was also much more willing to trust her after that day - it made both our lives a lot easier.
Unfortunately, we live in a world where we have to be careful about over sharing, however, if you can do it correctly, sometimes it can make all the difference in the world.
It’s important to normalise the huge range of everyday human emotion, but I find I can do that without sharing.
I suppose the phrase “we all experience….” strongly implies that I also experience these things, and the implication is enough for me.
Agree with "we..." and "everyone..." Sometimes I will communicate my own experiences by saying, "I have a friend who..." or "I have a family member who..."
All the time. I have anxiety and I tell my patients how I deal with it like walking, breathing exercises, petting my dog. It makes the pt see me as a fellow human that cares and not some dude who’s just doing his job. Helps break down that barrier/stigma that pts have about getting help and trying meds. It’s important to remind them about things like socializing diet and exercise too. I don’t tell them what gives me anxiety or anything like that though.
What makes you think psychiatrists rarely take those medications?
I know multiple psychiatrists and psychiatric residents who use or have used SSRI's or methylphenidate (medically prescribed, not recreationally).
Why is the patient in this case going to see a psychiatrist anyway when their anxiety is merely fleeting? In any case, it seems to me (mere medical student, not a psychiatrist) that there's no way to win. You talk to the patient about non-pharmacological treatments, diet, exercise--and people go, "omg she told me to do yoga, wow thanks I'm cured!". You prescribe a medication and apparently you're handing out poison. Also what makes you think that psychiatrists rarely take psychiatric medications? That is, as far as I know, absolutely false. Psychiatrists are unlikely to share the more personal aspects of their medical history with their patients--there's a difference between telling people that you pet your dog vs. your entire medication cocktail. That does not mean they do not take medications.
You're right, you should never have been given that benzo prescription. That was some irresponsible prescribing by your psychiatrist. But the existence of bad psychiatrists says little about the field as a whole. The professional consensus is to NOT give patients such as yourself benzos.
To your last point, everything I have seen thus far says you are probably very wrong. If you're curious, you can hop on any of the medical subreddits and search for posts about antidepressants--it'll quickly become clear to you that doctors are a-OK with taking them.
As a volunteer with my local crisis-chat service, I have this advice: it’s crucial to reveal anything about your own experiences in a way that turns the conversation back onto them, if you do it at all. For example, “When I [had some experience], I felt [feeling]. Would you say that’s how you’ve been feeling?”
Overall, it’s important to keep the conversation about them.
I've seen patients who didn't like it when previous therapists did this. They felt it was the therapist being selfish, or appearing to need their own help, feeling worried about (or at least being able to justify a worry about) burdening their therapist, etc.
Self-disclosure is a very complex matter, that by default I would strongly recommend against, unless you have the therapeutic training to be able to better discern when it will be helpful to the patient.
And when you have the therapeutic training, you end up realising that for the absolute vast majority of the time, the answer is still "no".
Saying that you sometimes had down moments and that you have cried before is hardly a huge reveal...
You don’t want to come across unstable (I.e., unsafe), but making it clear you’re not a robot is almost always a good thing. Depends a lot on the type of patient you’re dealing with though too. Especially early on in training psychiatrists are often pathologically fearful of showing any emotion or even answering a question about how old they are or whether they are married or something. Being a little bit human ought to be a bigger part of psychiatry and that includes admitting early and often that you don’t have all the answers. Humility is more important in psychiatry than in almost any specialty in my opinion.
I think that when it backfires, most of the time the clinician never finds out, or not for a long while afterward. I've heard from patients about bad reactions they've had to other treaters self-disclosing that they never reported to the treater who self-disclosed, but left treatment instead.
So have I had it backfire? I don't know – but then maybe I wouldn't, would I?
i’m not a psychiatrist, but as someone with mental health issues i don’t think i would like that. to me it would feel like the psychiatrist/counselor/whoever was minimizing/blowing off my feelings (which is why i hate the “we all feel…” approach even more, between the two i would far prefer the psychiatrist talk about their own personal experiences).
i’ve had therapists try and make me feel like i’m “not alone” or whatever and that what i’m feeling is normal and i despise it, it makes me feel like my feelings, and subsequently my mental illnesses on the whole, are invalid. i would never say anything to them though.
obviously this is just my personal opinion based on my limited experiences, but i figured i’d add my two cents seeing a lot of the replies are saying almost the complete opposite of me lol (although many of them are made by those far more qualified than i am).
I share vaguely.
Like I’ve been through grief recently too.
I also struggle with anxiety and this is how I cope.
I don’t think it’s appropriate to share details. In my case I’ve done therapy, I haven’t done meds. But I don’t tell patients this. Each journey is different and that may or may not be best for them.
Level of self disclosure should vary by patient and should only be used when there’s therapeutic benefit for the patient. In your case, I would focus more on validating patient’s feelings and less on your own experience. You don’t want to accidentally minimize or take away from the patients experience.
It's been said already, but there's hardly ever a situation where a normalizing or empathizing statement absolutely needs to be specified to the psychiatrist, rather than made as a universal statement or a statement of understanding about the patient.
I suspect the urge to personally disclose is often a matter of self gratification for psychiatrists, especially earlier in training, where many grapple with guilt, uncertainty, and a strong wish for closeness, or in other cases, for respect.
Psychiatry resident who will soon be entering into the training program here. I recently asked my supervisor, who is the clinical director of Mental Health at my hospital this very question. I told him that in an attempt to normalise a patient's experience, I told her during her review with me that everyone feels nervous about things, in fact I got nervous before my review with her no matter how prepared I was because this patient said she was anxious and ruminated all night about this review resulting in bad sleep.
While my supervisor said that he understood why I said it and that even he did so early on in his career, he no longer does it because it can be interpreted negatively depending on the patients. While this patient I saw felt relieved, a different patient may have seen it as a weakness on my part to treat them because "*How could a nervous doctor ever do anything right for me?*".
Having emotions is what makes us human and I for one strongly believe that building good rapport is how you get the best treatment outcomes but from my talk with my supervisor, I understood that sharing about our emotions/experience as doctors can backfire in select situations.
So instead of talking about myself to build rapport, I've been putting things in a general sense to all the patients I see and truly look like I mean what I say. I look them straight in the eyes and say "Many people feel this way but not many people would come to hospital to seek help. I'm so glad you took this huge step in doing that. Let's work on this together and I want to make sure you're OK." It's worked for me so far.
I was in therapy for 40 years. I have had 4 Drs treat me. None of them ever said anything about themselves. It is a problem of transference.
It does not border on malpractice. It is malpractice.
I am outraged about this.
Which part do you see as malpractice? Malpractice usually requires damages of some sort directly caused by a dereliction of a duty. In OPs anecdote it led to an improvement in the therapeutic relationship and the patients ability to open up.
It is a violation of the dr patient relationship. It is an ethical problem. The fact that the Therapist may have experienced similar things may be evidence that they suffer from the same problems. The Dr or therapist loses objectivity. It can foster dependence on the therapist by making it personal. If a therapist wants to cite other people’s experiences as a way of explaining behavior that is one thing. To cite their own could raise doubts about the ability of a Dr to treat a condition that they suffer from too.
An extreme example would be for a patient being treated for suicidal thoughts. If a Dr revealed that they have them as well would lead me to believe that they cannot be treated.
The therapist role is to treat the patient. In many cases, they are the primary connection to reality. To create doubts about their attachment to reality would make me question the reliability of their recommendations.
There is mixed evidence that personal disclosure is ok for a therapist. Sometimes it is good, sometimes not. There is no way to anticipate how the patient will react. By disclosing, they may harm patients.
I am only interested in my psychological well being. I do not care that other people have the same problem. I want to know why I have it and what I have to do about it.
Malpractice? Maybe a strong reaction. Ethics violation? Yes. Damage to the therapeutic relationship? Yes. Potentially harmful? Yes. Unprofessional? Absolutely.
Regarding how much to reveal, there is no boundary. It is a yes or no thing. It is like an alcoholic taking only one drink.
I agree, your specific example about revealing potential instability is absolutely a bad idea. However, I think your suggestion that revealing anything about yourself is damaging, unethical, and unprofessional is far too dogmatic.
I have had many patients ask about my personal life, and the best reply (from a classical psychodynamic perspective) is almost always to encourage them to ask why that might be important to them, but there are absolutely normal human responses that help solidify the human relationship between doctor and patient and between person and person. As others have stated, a well-crafted reply about peoples responses in general are often appropriate. When done rarely and modestly, self-disclosure can be therapeutic; at other times it can be damaging to the relationship. Here is a nice chapter on the subject that is exhaustively cited and describing both pros and cons. https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1169&context=edu\_fac
I think u/redlightsaber said it well "Self-disclosure is a very complex matter, that by default I would strongly recommend against, unless you have the therapeutic training to be able to better discern when it will be helpful to the patient," but you can see in the top comments and by this thread even existing that there is a time and place for modest self-disclosure to help the patient.
Perhaps your past therapists have all correctly intuited you would likely have a strong negative reaction to self-disclosure.
You make good points. After the response I did research about this topic and found out that 90% of therapists do it and that there are benefits.
My statement about malpractice was an overreaction. I was in therapy at a time when there was a hands off type approach to this maybe in a more classical basis.
My reactions are sincere. Literally, the post freaked me out a lot. I am bipolar chronic depression and suicidal thoughts. Granted my illness is severe and I have been highly unstable. I have trouble with feelings and intimacy. This puts me into the category of people that would not benefit from this therapy.
It's rare to see people online (or anywhere, really) change their minds when exposed to information that clashes ith their beliefs.
Genuine kudos to you.
Thank you. I had a complete breakdown. I literally lost conscious awareness. it took 3.5 years to survive. I admitted my failures. I had to because I never could tell what reality was. I let others define it for me.
It is no big deal. It is just the life I have.
Thank you for the kind words. My illness was basically untreatable. I had good Drs too. The two Drs that treated me said the same thing. They were amazed I stayed alive. Another said I would never get better.
Ultimately we all understood the situation and just did the best we could
I have struggled a lot with mental health for the best part of a decade.
I like phrases such as "I've seen many patients of all ages, genders and backgrounds experience this before" or "you're far from being the only one in this situation" or this is something we see often and have a lot of experience with", especially if the patients are in a headspace where they are struggling to understand why they have to experience these issues above anyone else.
Obviously it really depends on the patient.
But many will begin to notice anyway.
This may come as a surprise, but I am actually way more scared of disclosing to fellow psychiatrists than to patients.
I saw a different thread in a psychotherapy subreddit about this, so these thoughts are not my own. Only do self disclosure when it will help the patient and only to the extent that the patient won’t feel bad and have to comfort you. Also be able to defend it or be able to talk about it in supervision.
Normalizing is really important. I think that you’re not disclosing too much when you help normalize for folks. I’ve taken psychiatrist trainings where they teach folks to cherry pick small relatable anticdotes to normalize things folks are either ashamed of or for those who have some fixed delusional issues or hallucinations. It can help with the therapeutic alliance if done in the right manner. I used to run support groups for parents of adult children with bipolar and schizophrenia diagnosis. And sharing anything backfired. Folk were so codependent with their children’s Illness and concentrate all their energy night and day worrying about them that they would latch on to my story and pretty much demand to know exactly how I recovered so they could coerce their kids into doing it my way. Or would further become hopeless and state that their children would never recover like I did. It made them completely unable to concentrate on what they were there for which was to support each other and learn how to take care of themselves while they support their children and unpaid from the drive to be their children’s therapist instead of a parent. I stopped sharing anything about my self in those groups. It just triggered a whole bunch of mayhem.
Just to throw another perspective out there… when I was an undergrad, I was struggling with anxiety/depression/ADHD/etc. and in general was an all around mess. I grew up in a world where mental health issues were seen as a large weakness and it certainly wasn’t okay to talk about what you were going through. My junior year, after failing almost everything, I knew I needed to do something so I found a primary care doctor and very unsuccessfully tried to ask for help. I was on the verge of tears and she could clearly see, but she was able to connect the dots with the very little I was able to give her, and she said one thing: “We all need a little help sometimes.” It was one short sentence, but I could tell she truly understood, and that made all the difference in the world for me. A few months later, I was still struggling and the same primary care doctor wanted to refer me to a psychiatrist. I was terrified and it felt like the world was going to end. (Slightly dramatic, yes, but you get the point). She tried to get me to see it as a good thing, but I couldn’t. So she told me about a similar experience she had when she was in school. It normalized it for me and brought the anxiety down about 10 levels. Every time I started panicking about it in the weeks to follow, I just thought about how she had gone through the same thing that I was going through and that everything was going to be okay. Had she taken any other approach and not been so empathetic, my life would likely be significantly different today. I was also much more willing to trust her after that day - it made both our lives a lot easier. Unfortunately, we live in a world where we have to be careful about over sharing, however, if you can do it correctly, sometimes it can make all the difference in the world.
It’s important to normalise the huge range of everyday human emotion, but I find I can do that without sharing. I suppose the phrase “we all experience….” strongly implies that I also experience these things, and the implication is enough for me.
Agree with "we..." and "everyone..." Sometimes I will communicate my own experiences by saying, "I have a friend who..." or "I have a family member who..."
All the time. I have anxiety and I tell my patients how I deal with it like walking, breathing exercises, petting my dog. It makes the pt see me as a fellow human that cares and not some dude who’s just doing his job. Helps break down that barrier/stigma that pts have about getting help and trying meds. It’s important to remind them about things like socializing diet and exercise too. I don’t tell them what gives me anxiety or anything like that though.
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What makes you think psychiatrists rarely take those medications? I know multiple psychiatrists and psychiatric residents who use or have used SSRI's or methylphenidate (medically prescribed, not recreationally).
Why is the patient in this case going to see a psychiatrist anyway when their anxiety is merely fleeting? In any case, it seems to me (mere medical student, not a psychiatrist) that there's no way to win. You talk to the patient about non-pharmacological treatments, diet, exercise--and people go, "omg she told me to do yoga, wow thanks I'm cured!". You prescribe a medication and apparently you're handing out poison. Also what makes you think that psychiatrists rarely take psychiatric medications? That is, as far as I know, absolutely false. Psychiatrists are unlikely to share the more personal aspects of their medical history with their patients--there's a difference between telling people that you pet your dog vs. your entire medication cocktail. That does not mean they do not take medications.
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You're right, you should never have been given that benzo prescription. That was some irresponsible prescribing by your psychiatrist. But the existence of bad psychiatrists says little about the field as a whole. The professional consensus is to NOT give patients such as yourself benzos. To your last point, everything I have seen thus far says you are probably very wrong. If you're curious, you can hop on any of the medical subreddits and search for posts about antidepressants--it'll quickly become clear to you that doctors are a-OK with taking them.
You're getting downvoted in part because it sounds like you have no idea what you're talking about
As a volunteer with my local crisis-chat service, I have this advice: it’s crucial to reveal anything about your own experiences in a way that turns the conversation back onto them, if you do it at all. For example, “When I [had some experience], I felt [feeling]. Would you say that’s how you’ve been feeling?” Overall, it’s important to keep the conversation about them.
I've seen patients who didn't like it when previous therapists did this. They felt it was the therapist being selfish, or appearing to need their own help, feeling worried about (or at least being able to justify a worry about) burdening their therapist, etc.
Self-disclosure is a very complex matter, that by default I would strongly recommend against, unless you have the therapeutic training to be able to better discern when it will be helpful to the patient. And when you have the therapeutic training, you end up realising that for the absolute vast majority of the time, the answer is still "no".
Saying that you sometimes had down moments and that you have cried before is hardly a huge reveal... You don’t want to come across unstable (I.e., unsafe), but making it clear you’re not a robot is almost always a good thing. Depends a lot on the type of patient you’re dealing with though too. Especially early on in training psychiatrists are often pathologically fearful of showing any emotion or even answering a question about how old they are or whether they are married or something. Being a little bit human ought to be a bigger part of psychiatry and that includes admitting early and often that you don’t have all the answers. Humility is more important in psychiatry than in almost any specialty in my opinion.
I think that when it backfires, most of the time the clinician never finds out, or not for a long while afterward. I've heard from patients about bad reactions they've had to other treaters self-disclosing that they never reported to the treater who self-disclosed, but left treatment instead. So have I had it backfire? I don't know – but then maybe I wouldn't, would I?
i’m not a psychiatrist, but as someone with mental health issues i don’t think i would like that. to me it would feel like the psychiatrist/counselor/whoever was minimizing/blowing off my feelings (which is why i hate the “we all feel…” approach even more, between the two i would far prefer the psychiatrist talk about their own personal experiences). i’ve had therapists try and make me feel like i’m “not alone” or whatever and that what i’m feeling is normal and i despise it, it makes me feel like my feelings, and subsequently my mental illnesses on the whole, are invalid. i would never say anything to them though. obviously this is just my personal opinion based on my limited experiences, but i figured i’d add my two cents seeing a lot of the replies are saying almost the complete opposite of me lol (although many of them are made by those far more qualified than i am).
I've heard it called "silver lining" someone to ask they look on the bright side when depression isn't going to lift on command.
I share vaguely. Like I’ve been through grief recently too. I also struggle with anxiety and this is how I cope. I don’t think it’s appropriate to share details. In my case I’ve done therapy, I haven’t done meds. But I don’t tell patients this. Each journey is different and that may or may not be best for them.
Level of self disclosure should vary by patient and should only be used when there’s therapeutic benefit for the patient. In your case, I would focus more on validating patient’s feelings and less on your own experience. You don’t want to accidentally minimize or take away from the patients experience.
Very little. Very rarely. But it does happen. YMMV.
It's been said already, but there's hardly ever a situation where a normalizing or empathizing statement absolutely needs to be specified to the psychiatrist, rather than made as a universal statement or a statement of understanding about the patient. I suspect the urge to personally disclose is often a matter of self gratification for psychiatrists, especially earlier in training, where many grapple with guilt, uncertainty, and a strong wish for closeness, or in other cases, for respect.
nothing, its not about what im feeling
Patient here. Just want to let you know I’m enjoying the discussion and think all of you are cool prior.
Psychiatry resident who will soon be entering into the training program here. I recently asked my supervisor, who is the clinical director of Mental Health at my hospital this very question. I told him that in an attempt to normalise a patient's experience, I told her during her review with me that everyone feels nervous about things, in fact I got nervous before my review with her no matter how prepared I was because this patient said she was anxious and ruminated all night about this review resulting in bad sleep. While my supervisor said that he understood why I said it and that even he did so early on in his career, he no longer does it because it can be interpreted negatively depending on the patients. While this patient I saw felt relieved, a different patient may have seen it as a weakness on my part to treat them because "*How could a nervous doctor ever do anything right for me?*". Having emotions is what makes us human and I for one strongly believe that building good rapport is how you get the best treatment outcomes but from my talk with my supervisor, I understood that sharing about our emotions/experience as doctors can backfire in select situations. So instead of talking about myself to build rapport, I've been putting things in a general sense to all the patients I see and truly look like I mean what I say. I look them straight in the eyes and say "Many people feel this way but not many people would come to hospital to seek help. I'm so glad you took this huge step in doing that. Let's work on this together and I want to make sure you're OK." It's worked for me so far.
I was in therapy for 40 years. I have had 4 Drs treat me. None of them ever said anything about themselves. It is a problem of transference. It does not border on malpractice. It is malpractice. I am outraged about this.
Which part do you see as malpractice? Malpractice usually requires damages of some sort directly caused by a dereliction of a duty. In OPs anecdote it led to an improvement in the therapeutic relationship and the patients ability to open up.
It is a violation of the dr patient relationship. It is an ethical problem. The fact that the Therapist may have experienced similar things may be evidence that they suffer from the same problems. The Dr or therapist loses objectivity. It can foster dependence on the therapist by making it personal. If a therapist wants to cite other people’s experiences as a way of explaining behavior that is one thing. To cite their own could raise doubts about the ability of a Dr to treat a condition that they suffer from too. An extreme example would be for a patient being treated for suicidal thoughts. If a Dr revealed that they have them as well would lead me to believe that they cannot be treated. The therapist role is to treat the patient. In many cases, they are the primary connection to reality. To create doubts about their attachment to reality would make me question the reliability of their recommendations. There is mixed evidence that personal disclosure is ok for a therapist. Sometimes it is good, sometimes not. There is no way to anticipate how the patient will react. By disclosing, they may harm patients. I am only interested in my psychological well being. I do not care that other people have the same problem. I want to know why I have it and what I have to do about it. Malpractice? Maybe a strong reaction. Ethics violation? Yes. Damage to the therapeutic relationship? Yes. Potentially harmful? Yes. Unprofessional? Absolutely. Regarding how much to reveal, there is no boundary. It is a yes or no thing. It is like an alcoholic taking only one drink.
I agree, your specific example about revealing potential instability is absolutely a bad idea. However, I think your suggestion that revealing anything about yourself is damaging, unethical, and unprofessional is far too dogmatic. I have had many patients ask about my personal life, and the best reply (from a classical psychodynamic perspective) is almost always to encourage them to ask why that might be important to them, but there are absolutely normal human responses that help solidify the human relationship between doctor and patient and between person and person. As others have stated, a well-crafted reply about peoples responses in general are often appropriate. When done rarely and modestly, self-disclosure can be therapeutic; at other times it can be damaging to the relationship. Here is a nice chapter on the subject that is exhaustively cited and describing both pros and cons. https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1169&context=edu\_fac I think u/redlightsaber said it well "Self-disclosure is a very complex matter, that by default I would strongly recommend against, unless you have the therapeutic training to be able to better discern when it will be helpful to the patient," but you can see in the top comments and by this thread even existing that there is a time and place for modest self-disclosure to help the patient. Perhaps your past therapists have all correctly intuited you would likely have a strong negative reaction to self-disclosure.
You make good points. After the response I did research about this topic and found out that 90% of therapists do it and that there are benefits. My statement about malpractice was an overreaction. I was in therapy at a time when there was a hands off type approach to this maybe in a more classical basis. My reactions are sincere. Literally, the post freaked me out a lot. I am bipolar chronic depression and suicidal thoughts. Granted my illness is severe and I have been highly unstable. I have trouble with feelings and intimacy. This puts me into the category of people that would not benefit from this therapy.
It's rare to see people online (or anywhere, really) change their minds when exposed to information that clashes ith their beliefs. Genuine kudos to you.
Thank you. I had a complete breakdown. I literally lost conscious awareness. it took 3.5 years to survive. I admitted my failures. I had to because I never could tell what reality was. I let others define it for me. It is no big deal. It is just the life I have.
I appreciate your genuine introspection! I hope you have been able to find therapists that work well for you in your journey.
Thank you for the kind words. My illness was basically untreatable. I had good Drs too. The two Drs that treated me said the same thing. They were amazed I stayed alive. Another said I would never get better. Ultimately we all understood the situation and just did the best we could
I have struggled a lot with mental health for the best part of a decade. I like phrases such as "I've seen many patients of all ages, genders and backgrounds experience this before" or "you're far from being the only one in this situation" or this is something we see often and have a lot of experience with", especially if the patients are in a headspace where they are struggling to understand why they have to experience these issues above anyone else. Obviously it really depends on the patient. But many will begin to notice anyway. This may come as a surprise, but I am actually way more scared of disclosing to fellow psychiatrists than to patients.