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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Dinah on October 29, 2002, at 16:57:35
My pdoc has a very clear boundaries about the separation of therapeutic issues and psychopharmacology. In other words, he's only interested in medication issues, symptoms, and side effects, and effectiveness of medication. He might want to hear if I've had increased suicidal ideation, if I've been having trouble sleeping, or if I've had increased anxiety. But other than things like that, he just questions me about my meds. And I am perfectly ok with that. In fact he's refreshing to me after my last overintrusive pdoc. Plus, I like the meds he has me on.
I asked my therapist today for his view of whether I'm doing worse, since that's sometimes sort of hard to judge for myself. And I discovered that he doesn't like the lack of communication with my pdoc. He feels that at the very least, I should be completely honest with my pdoc about everything, including non physiological purely psychological problems. I on the other hand think that not only would my pdoc not be interested, but I also think it's none of his business. What I say in therapy should remain in therapy.
Is it general practice for the therapist to be in contact with the psychopharmacologist? My therapist seems to think that the lack of communication is unusual. And is it necessary for the pychopharmacologist to know everything?
My last pdoc was in contact with my therapist, and I think it turned out poorly. That may be influencing my thoughts on the subject.
Posted by judy1 on October 29, 2002, at 20:11:45
In reply to How honest should I be with my pdoc?, posted by Dinah on October 29, 2002, at 16:57:35
Hi Dinah,
I can only tell what works for me- and that's total communication between all parties- the shrink, therapist, internist and neurologist (when necessary). but then again my shrink is a big believer in alternative treatments (supplements,etc.) and also does therapy. I think insurance caused the great divide of therapy and pharmacology- when in fact it's critical to monitor someone's moods (especially someone like yourself on the bipolar spectrum) in response to meds. To me, that means asking all the questions- but in turn that takes more than 15-20 minutes and your insurance probably won't cover it (mine doesn't). so if you feel comfortable with the situation as it stands, then that's good- but I have to agree with your therapist that communication is critical. hope this didn't confuse you more- take care, judy
Posted by mair on October 29, 2002, at 21:14:16
In reply to Re: How honest should I be with my pdoc? » Dinah, posted by judy1 on October 29, 2002, at 20:11:45
Dinah
I've always been in situations where my pdoc and therapist communicate so that's what I'm most comfortable with. I found my therapist through my ex-pdoc and my now-pdoc through my therapist. It's not like they communicate alot, but I think my pdoc reports to my therapist every time I've met with her (even if just by voice mail), and I know my therapist has called my pdoc when she's been particularly concerned about me. I am not the only patient they share.
I'm not sure that my pdoc needs to talk to my therapist as much as my therapist needs to know what's going on meds-wise, although my pdoc does always want an update, albeit brief, with how things are going in therapy. I think she may feel that she can be a little less vigilant since she knows that I'm being seen regularly, and that my therapist is pretty watchful.
Some time ago I got rather suicidally depressed after starting serzone. I was too wrapped up with how miserable I was feeling to realize that what was going on with me was probably related to the drug. My therapist spotted it, discussed it with my pdoc and made sure I contacted my pdoc, although I really didn't want to. The fact that my pdoc had already heard from my therapist made it a little easier for me to explain what was happening and it was obviously critical that my therapist was able to identify that some of what was happening was drug related. I'm not sure how well all that would've played out had they not known one another at all.
Mair
Posted by jane d on October 30, 2002, at 5:33:54
In reply to How honest should I be with my pdoc?, posted by Dinah on October 29, 2002, at 16:57:35
What about asking your therapist what, if anything, he thinks you should tell your psychiatrist before your next appointment? You can then decide whether or not it is something the psychiatrist needs to know. It leaves you in control of the communication while still giving you the chance to take advantage of any observations your therapist has made.
Jane
Posted by NikkiT2 on October 30, 2002, at 6:04:03
In reply to Re: How honest should I be with my pdoc? » Dinah, posted by jane d on October 30, 2002, at 5:33:54
My therapist (who is a psychologist with an md) doesn't have any contact with my Pdoc at all... even though they're in the same team!!! *lol*
BUT - I have asked my therapist to speak with my pdoc as I don't like him and don't like his so called plan for me... first time I saw him he changed my meds which I was relatively stable on as he doesn't believe in the use on anti -psychotics (I was on zyprexa and found it a life saver).. and even though i said I didn't want another ssri he has put me on ciprimil.
I know my therapist won't tell the pdoc any real details of what i ahve been saying to her, but shuld hopefully help the relationship I have with the pdoc!!
Nikki
Posted by Dinah on October 30, 2002, at 17:20:05
In reply to Re: How honest should I be with my pdoc?, posted by NikkiT2 on October 30, 2002, at 6:04:03
How awful to not like your pdoc! I was in that situation at one time and eventually got rid of him. Are you stuck with this one? I think it helped my mental health just to get away from that... Well. Anyway. Has anything improved with your therapist's intervention?
Posted by Dinah on October 30, 2002, at 17:23:37
In reply to Re: How honest should I be with my pdoc? » Dinah, posted by jane d on October 30, 2002, at 5:33:54
Tried it Jane. :)
My therapist isn't the blank slate type. But he can be as maddeningly elusive as Dr. Bob sometimes. It must be something they teach them in Psychology 101. So I have to assume that what he would like to tell pdoc may well be something he would rather not tell me. Especially since that was the case last time. :(
And I'd just as soon anything insulting said about me be said with my full knowledge. Or better yet, not said at all.
Posted by Dinah on October 30, 2002, at 17:30:58
In reply to Re: How honest should I be with my pdoc?, posted by mair on October 29, 2002, at 21:14:16
I'm glad that they were able to work together to help you. My therapist always asks me about any med changes and notes them (one of the few things he takes notes about).
He seems to feel surprisingly strongly about the communication issue though, enough to say something uncomplimentary about my pdoc which is not like him at all. And it might turn out differently than last time. The last pdoc was quite... volatile, and I think they egged each other on in excessive concern. My current pdoc is completely unflappable, and may in fact, calm my therapist down about things like cutting which my therapist takes far too seriously and my pdoc doesn't react to at all "mmm hmmm. and how severe would you label this cutting behavior. i see.".
Posted by Dinah on October 30, 2002, at 17:39:44
In reply to Re: How honest should I be with my pdoc? » Dinah, posted by judy1 on October 29, 2002, at 20:11:45
Well, I'm completely private pay on psychiatrists (I didn't want to go through certification process), so it's entirely my pdoc's choice to have 5-10 minute meds checks every few months. And I'm really ok with it.
Except of course that you're right about having someone monitoring my moods from the outside. I am a lousy judge of how my moods have been over an extended period. I only know what I feel now.
But I'm really afraid to have therapist talk to current pdoc. Prior pdoc conferred with therapist regularly, and therapist conveyed some impressions of me that led me to be labelled as schizotypal personality disorder by the pdoc fairly early in treatment. Pdoc didn't have a hint of discretion and casually told me that I was personality disordered and really couldn't expect too much in the way of a range of emotions or being able to relate to others. Therapist was furious with pdoc for letting me in on the secret personality disorder diagnosis, but pretty much confirmed that he was in on it.
It disrupted therapy for at least a year, and I don't want to be hurt like that again.
Posted by judy1 on October 30, 2002, at 18:04:36
In reply to Re: How honest should I be with my pdoc? » judy1, posted by Dinah on October 30, 2002, at 17:39:44
i completely understand your feelings, if i had had the same experience it would have taken me ages to trust again (a year sounds about right). I know it's difficult not to carry those feelings over to the new team, but i think you agree about the mood monitoring. even though the pdoc is strictly a meds dr., he still needs to know where you stand when prescribing- and that objectivity has to come from the therapist unfortunately. it probably isn't his business to know about the personality disorder since he isn't treating that-your therapist is- but he really should know about the mood disorder. take care, judy
Posted by Dinah on October 31, 2002, at 0:58:19
In reply to Re: How honest should I be with my pdoc? » Dinah, posted by judy1 on October 30, 2002, at 18:04:36
It helped me to remember one thing that I find very helpful at Babble. It's a good place to clarify feelings. About everything really, but especially about therapy. I guess that's because other events you can process in therapy, but sometimes it's hard to process therapy itself in therapy.
It's amazing what pops out of my mind in response to posts. Things that I wasn't even aware I was thinking.
Thanks, guys.
Posted by NikkiT2 on October 31, 2002, at 6:09:41
In reply to Re: How honest should I be with my pdoc? » NikkiT2, posted by Dinah on October 30, 2002, at 17:20:05
Can't change really... in the UK you just get assigned to a "team" and the boss of this team is *really* nasty so I won't see him... my old pdoc was heavenly.. so so nice... he was young, cute, enthusiastic and willing ti listen to what I had learnt and wanted.. the new guy hardly speaks any English and mumbles when he does, and is really set in his ways med wise... grrrrr
Only worked up the guts to speak to my therapist about it last tuesday, so don't know what has come of it yet...
Will let you know if it helps at all!!!
Nikki
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