I just had an intake appointment with the 5th psychologist in less than 2 years. It’s not because I spent a lot of time “shopping” for the right fit, in fact I would have loved to stay with #3 or #4. It’s because this is how the Dutch mental health care system seems to work*. At the end of the intake appointment, #5 noted that it was good I was able share so openly with her. “Yeah, I guess…” I responded awkwardly. But on the inside I was thinking “Yeah, I’m doing this for the 5th time in 2 years. I just want to finally get to the point.”
I had just spent an hour basically speed-running her through my struggles and insecurities and all the insights I had gained in the last 2 years with the other 4 psychologists. I somewhat bluntly listed details of a traumatic experience that took me months to open up to #4 about, and I had not ever mentioned to #1-3. She asked the questions I answered 4 times already (childhood, parents, relationship, work, hobbies). She asked the predictable questions to screen for depression, anxiety, PTSD. She gave me a questionnaire to fill out at home that was similar to the one #2 and #3 had also given me. We confirmed the next appointment, and I went home.
#1 was the in-house psychologist at my GP’s office (“POH-GGZ”). I had one intake/screening appointment with her in autumn of 2019, where she asked me about my childhood, family and work, went through some basic screening questions for depressive symptoms before deciding it was best for me to get care elsewhere and referred me to #2.
After a few months of waiting, I had my first appointment with #2 in January 2020 (I could write a whole other blog about how absolutely soul-crushing it was to start 2020 feeling hopeful that I was going to get better and going to get my mental health under control, only to have that completely derailed by a pandemic). Another intake session going over childhood, family, work, relationship, friends, hobbies. A take-home screening questionnaire, then finally a diagnosis (anxiety) and treatment plan (acceptance-commitment therapy). Ultimately, #2 was not a good fit for me, and COVID also kind of took over our sessions even though that was not what I was there for. After a few months, where I kept waiting for the benefits of therapy to kick in, #2 told me that she had given me the tools I needed to continue on my own, and that was the end of our time together. I later learned that this was because my referral was for “basis GGZ” (basic mental health care) and we had reached the limit covered by health insurance.
#3 was the new in-house psychologist at my GP’s office, who I started seeing in November 2020. I was initially hesitant to go through this route again because the last time didn’t seem to work out, but this seems to be standard practice due to long waitlists elsewhere. Another intake talking about all the relevant topics, another screening questionnaire. In the end, #3 was great. I felt like she understood me, and really truly cared about helping me. Unlike with #2, I felt comfortable enough to tell her when I didn’t like how things were going, and she adapted to that. As “POH-GGZ” typically only do short-term counselling over a few sessions, I asked for another referral. #3 took time to work with me to figure out what kind of referral would be best for me. I would have loved to stay with her, because I really felt like we had a good connection. But alas, that is not how the system works.
In February 2021 I had my intake with #4. My referral was once again for basic mental health care, as this typically comes with shorter waitlists, but I was told that this could also be changed depending on the intake. Another screening, another round of talking about my childhood and family and relationship and work. Another diagnosis (this time anxiety + depressive episode), and a new treatment plan (cognitive-behavioral therapy). We decided to stick with the basic mental health care referral, because if it turned out in the end that this was not enough, I could get an internal referral for “specialistische GGZ” (specialist mental health care) for continued care. #4 was great as well. I felt like I could build on the progress I had made with #3. Eventually, a few sessions before the end of the trajectory with #4, I was able to open up about some past experiences that just didn’t feel right to share until then (thinking back now I realize I had hinted at it once with #2, but she never followed up on it). We realized that these experiences might be contributing to my current state of mind. But, because I was on the “basis GGZ” trajectory, our time together was coming to an end and so we would not have time to work on this together anymore.
So I got my internal referral for specialist care, and that is how I found myself with #5. And at this point I feel tired. Tired of starting and stopping so many times. #3 told me that I had to be patient, because it wouldn’t just get better overnight, these things take time. But every time I have felt like I was getting somewhere, our time was up, and I had to wait for my intake with the new person. And then work on building a new relationship, getting used to their style, understanding what their reactions mean. As I was throwing all of my history at #5 to try to get her up to speed, I couldn’t help but wonder if maybe the fact that I am sharing these experiences so openly with her somehow takes away a bit of their weight. #4 had to coax them out of me after I was stuck sobbing in silence for several minutes, but here I was just listing them like they were any other part of my medical history. #5 reacted with kindness and compassion and asked good follow up questions to try to get a picture of the impact of these experiences on my life. I do have hope that this will be a good fit. But I am still left wondering whether she will ever really understand the way that #4 seemed to, or whether I will ever feel as comfortable telling her that I don’t like an approach as I did with #3.
- by anonymous
* I know now from others that there may be ways to get mental health care with more continuity, but those seem to require either going without insurance coverage, paying upfront and hoping for reimbursement, or going through this cycle again and again until your health insurance realizes that, yes, you really do need more than the standard packages can offer. It also requires knowing a bit about the system and being able to advocate for yourself and your needs. I entered the system not knowing what to expect, not knowing what I would want or need, and trusting in the professionals to steer me in the right direction, and this has been my experience.
