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Dr. Bob is Robert Hsiung, MD,
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Posted by CareBear04 on January 12, 2005, at 4:02:32
hi-- i haven't really been through the archives on this board, but i was wondering if anyone has experience with pdocs who manage their meds and also do therapy.
i've had two such drs, both psychiatrists who did analytic training to become psychoanalysts. they have the couch and everything, but i've never used it. at most, i've gone in 3x a week; i'm currently going once or twice.
i'm just not a therapy person. i sort of just want my pdoc to manage my meds and not push me into looking for a psychological/circumstance-related cause for everything, espeically problems that i think are primarily medical and can be explained by drugs/meds and such. one of the pdocs practiced in NYC where analysis is much more the rage, and i think he outsourced the prescribing to a psychopharmacologist. he did do meds for me, but after six weeks of seeing him, he showed me the list of meds he had written for me, and it was longer than the list of meds for all his patients in the past three years. my pdoc now manages meds on her own, and though i think she's wonderful, i sometimes think she should stick to therapy and delegate the med management to someone with more experience with drugs. i definitely think it helps to have a pdoc prescribe meds after talking to you at length and not just a 20-min checkup every month. still, i've ventured out of the realm of the familiar SSRIs and other frequently-prescribed drugs into more remote ones, and am currently on a nasty cocktail of 11 or 12 meds. i think that's enough to make anyone loopy and not herself, but the pdoc/T keeps pushing to find a psychological trigger or cause.
i've heard it said that meds pollute the transference. i'm not sure really of what that means except that a pdoc who does therapy is more likely less forceful about med choices because of the need to preserve the therapeutic relationship than one who deals only with meds.
have others been seeing or have seen pdocs as Ts? how do they balance the dual roles of prescribing and talking? the ones i've seen put their faith in talking so much that it baffles me why they would go to medical school, do a psych residency, hone those prescribing skills, and then invest 5+ more years and lots of money into analytic training. that alone i find puzzling but more so the pdoc analysts who then don't prescribe. why go through so much trouble getting a medical degree and learning to use meds as tools... only never to use them again? seems like a PhD would make more sense if that's the type of practice they desire.
anyone have any thoughts? doesn't have to directly relate-- anything even touching on the questions would be appreciated. thanks!
Posted by fallsfall on January 12, 2005, at 8:28:52
In reply to pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 4:02:32
I have always seen a PhD for therapy and a pdoc for meds.
I used to be on a lot of meds (I think 9 different prescriptions), but now I'm down to 2 (Prozac and Synthroid - and the Synthroid isn't really depression related).
A year and a half ago I changed therapists, and my new therapist wasn't thrilled with me being on so many meds. It took me most of the year and a half to get off what I was on - trying to find a "stable" time and changing only one thing at a time was logistically very hard. The combination I was taking made sense to me - each new med had been added after a lot of thought, and I knew why I was taking each one.
I am feeling better now. I'm not sure it is because I'm off the meds. During this time my therapist (who does work with a couch for some patients) has been working intensely (3X week) through transference issues with me (including where I *need* to please those in authority, so do I please him or my pdoc??). I think I credit the therapy more than the lack of meds.
I like having a different person prescribing meds for me. He used to schedule 2 patients/hour so we did have time to talk and over the 10 years I've been seeing him he knows me pretty well now. He schedules 3 patients/hour now, so the appointments are shorter - I'm glad that I had the benefit of getting to know him with the longer appointments first. It is helpful because if I have a real issue with one of them, I can talk to the other. They have talked together once or twice, and that was valuable. It also means that when one goes on vacation the other is usually still around so I don't feel like my safety net has completely disappeared.
For me, meds are necessary (sometimes they have kept me alive), but therapy is what is going to make the difference in my life.
Posted by GoodEnough on January 12, 2005, at 9:32:52
In reply to pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 4:02:32
I see a therapist who is also my pdoc, an MD. I am in the process, almost complete, of tapering off of my anti-depressant. So far, so good - I am down to 1/4 of my original dose. My plan is to not go back onto another AD, but if the depression symptoms come back, I will. If I don't go back onto pills, then I will be seeing a pdoc/T only for therapy.
I (and my T) believe that most of my symptoms are related to my painful past. We work with dreams and current issues that come up in my life to heal those deep wounds. It is working very well for me.
I used to believe that all I needed was to find the right pill to make me feel better. I saw a whole string of therapists who were PhD psychologists and MSSW social worker but never formed a good therpeutic relationship (I saw separate pdocs for meds during those times). I have been in and out of treatment either because I felt better or since my HMO clinic is associated with a teaching hosipital, I suffered through many short term therapies with in T who graduated.
This past year, I finally had the guts to ask my current pdoc, who I was becoming very fond of, if I could see him in his private practice. It has made a world of difference to me - more because of who he is and his long term experience than the fact that he is an MD.
My T is a professor at a University and also an expert in a type of psychotherapy. He has written many books and articles, in some, I have been featured as a case.
Posted by GoodEnough on January 12, 2005, at 9:33:00
In reply to pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 4:02:32
I see a therapist who is also my pdoc, an MD. I am in the process, almost complete, of tapering off of my anti-depressant. So far, so good - I am down to 1/4 of my original dose. My plan is to not go back onto another AD, but if the depression symptoms come back, I will. If I don't go back onto pills, then I will be seeing a pdoc/T only for therapy.
I (and my T) believe that most of my symptoms are related to my painful past. We work with dreams and current issues that come up in my life to heal those deep wounds. It is working very well for me.
I used to believe that all I needed was to find the right pill to make me feel better. I saw a whole string of therapists who were PhD psychologists and MSSW social worker but never formed a good therpeutic relationship (I saw separate pdocs for meds during those times). I have been in and out of treatment either because I felt better or since my HMO clinic is associated with a teaching hosipital, I suffered through many short term therapies with in T who graduated.
This past year, I finally had the guts to ask my current pdoc, who I was becoming very fond of, if I could see him in his private practice. It has made a world of difference to me - more because of who he is and his long term experience than the fact that he is an MD.
My T is a professor at a University and also an expert in a type of psychotherapy. He has written many books and articles, in some, I have been featured as a case.
Posted by Joslynn on January 12, 2005, at 11:01:36
In reply to pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 4:02:32
When I was very severely depressed three years ago, I did therapy plus med management for an hour a couple times a week for 1-2 weeks with pdoc. Then I got an MSW therapist (much cheaper and a woman, which I wanted) for regular weekly therapy, still seeing pdoc for an hour every 4 weeks for therapy.
I have cut down on the therapy with the pdoc because I was getting too emotionally dependent and it just wasn't working for me anymore to have that yearning and oversensitivity to every little thing he said. It's a long story. I still see him, but less often and for shorter lengths of time. I miss him very much, but it was something I had to do.
I think a pdoc can be a great therapist, if it's the right person. This split of having pdocs just for meds and MSWs/counselors for psychotherapy is a recent trend, started in part by the insurance industry I believe. Pdocs used to do much of the therapy as well.
For me, the therapy is important because my depression has situational triggers. Yes it runs on my father's side of the family (mixed in with alcoholism) and does seem to have biological components, but I can usually trace the beginnings of an episode to an emotional trigger. So I am using the therapy with the female T to manage those triggers. (That sounds so "therapy-ish" doesn't it.)
I think that ideally, having one person to do the meds and therapy would be the best, actually, if it's a good doctor who is as good with people as he or she is with meds. That may be hard to find though...
Posted by CareBear04 on January 12, 2005, at 11:43:21
In reply to Re: pdocs who do therapy, posted by Joslynn on January 12, 2005, at 11:01:36
hi everyone-- thank you all for your responses and for sharing your experience.
like a few of you mentioned, therapy is a really big piece that can get you or keep you off meds. yesterday, with my pdoc, i was sort of lamenting ever starting meds. depression does run in my family, too, as does alcoholism, but my family is really religious and from a different culture where mental illness is taboo, so i'm sure there's more sick people than we acknowledge in my family. though there's a lot of depression, i'm the only one to be diagnosed as Bipolar, and though the diagnosis comes up with almost every practitioner, no one is really sure it's the right fit.
being on the mess of meds that i'm on, i do wonder where i would be now if i were more of the therapy person and was able to make use of intensive therapy to deal with the problems that came up. i was really high-functioning-- though i was super-depressed, i still managed to stay on top of a crazy schedule and keep up with my responsibilities. and my depression was for good reasons, if there is such a thing-- one of my best friends died from a drug overdose, i was an RA and TA and student leader and had too many people to take care of to take care of myself, and i wasn't getting more than 3-4 hrs of sleep over months. also, i think i was going through a normal neurotic teenage existential crisis. i've always been intrigued by authors like sartre and camus, and i did a minor in french literature and society, so i spent a lot of time reading depressing stuff about the meaninglessness of life and its absurdity. after a month of so of teeth-pulling in therapy, the T referred me to a pdoc for meds. i was put on lexapro, which within weeks, gave me something like akathisia so i couldn't sit or sleep or stop shaking, and all of a sudden, i became obsessed with throwing myself out windows or off high buildings. i started having morbid hallucinations and saw blood everywhere and paranoid delusions about people on the street wanting to kill me and spy cameras in my own room. the drug just messed me up really bad and made me out of control until i ended up spontaneously taking handfuls and handfuls of pills and landing in the ICU. that was the first time i had to leave school.
once in the hospital, they're pretty set on putting you on meds. since about two years ago, i've been constantly medicated on no less than 5-6 drugs at a time. between march-august of 2003, i lived in a fog, stabilized on lithium but below baseline and still depressed, though not suicidal. the cognitive impairment was really bad, my pdoc wouldn't work with me to find better meds or taper the doses down, so finally, i took myself off everything at once... not smart. effexor withdrawal especially was horrible not just physically; it send me spiraling immediately into the worst and blackest depression of my life. i was referred to a new pdoc back in NYC, and i left four messages and never got a response. i turned to everyone who would know some names, looking for anyone who could just get me back on my meds. it wouldn't have been that hard, but i didn't find anyone to the point that i gave up and felt like no one could or would help me. so i planned every detail of a deliberate and lethal suicide and am super-lucky to have made it alive.
that was a year and a half ago, and i've been on med after med-- dozens in total-- and am now on about 12. i can't help but feel that if i had worked hard in therapy and made myself overcome this reluctance to talk, i could have avoided meds or could at least be on less. when i look back, it's really the meds that caused the worst problems-- the lexapro, the effexor, and most recently, narcotic painkillers. i ended up missing a year of college and ending up deciding just to graduate with my class having only three years of what are often referred to as the best years in a person's life. when i did get back into school, i was living in a fishbowl, was required to see a shrink 3x a week and check in with my "parole officer," a school shrink once every two weeks. it was overkill, and as someone who really values privacy and independence, it was really constricting and frustrating to have so many eyes watching for me to slip.
i'm not bitter about my experiences, but i am curious about what could have been. i used to be a big believer in meds and the biological, but experiencing so much trouble from meds recently, i know at least in theory that therapy can be healing and important. i just wish i could learn to make use of it and open up. there's a quote in an article someone sent me that i really like: "the world loves talent but pays off in character." all of us who have been through the ups and downs and struggles of mental illness will surely come out with a hell of a lot of character!
best wishes to you all. thanks for your support!
Posted by mair on January 12, 2005, at 17:01:35
In reply to Re: pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 11:43:21
For about 2 years I did therapy 2x a week with my pdoc who also managed my meds. In retrospect that didn't work as well for me as my situation now - a PhD for therapy and a pdoc for meds. Pdocs love to talk about meds, and I'd get frustrated over therapy sessions which never seemed to get beyond a discussion about meds. Also, I actually think he didn't have the best perspective about what was working and what wasn't, because he never seemed to suggest changes when things probably really weren't working.
My current T tends to be the person who best spots when maybe I need to make medication adjustments. Maybe it also has something to do with age and orientation. My old pdoc was a classically trained psychoanalyst although he was doing basic psychodynamic therapy with me, as is my current T. The difference is that I think he was trained to give the patient very little feedback, so I don't think of him as being a particularly good communicator. My current T doesn't have to think about the meds stuff as much so she probably pays more attention to how I'm actually doing. It's also like having 2 people keeping an eye on things which seems better to me also.
This is just my experience.
Mair
Posted by CareBear04 on January 12, 2005, at 20:37:17
In reply to Re: pdocs who do therapy » CareBear04, posted by mair on January 12, 2005, at 17:01:35
thanks, mair. that makes a lot of sense. my pdoc does psychodynamic with me, too. i think the difference with the two analysts i've seen is that they're pretty young, analytically trained but not dogmatic in the old-school sense. they take freud with a grain of salt and do give feedback. but i haven't really had typical therapeutic relationships, either. i mean i talk mostly meds with my current pdoc, don't really have transference/attachment to them, have not had restrictions on physical contact or anything (though it's not like i seek it ever), and talked books and movies with my old pdoc 3x a week. sounds like your old analyst was more classically oriented in his approach. it also sounds like your new T is working well for you and so is the split between therapy and meds. i can see how that would work well. most psychologists or even social workers i've come across are pretty well-educated about meds, even if they can't prescribe them, so it makes sense that your T can spot a problem and help you, esp if there's good lines of communication between the two. sounds cool...
Posted by Poet on January 13, 2005, at 22:22:26
In reply to pdocs who do therapy, posted by CareBear04 on January 12, 2005, at 4:02:32
Hi Carebear,
From the first appointment Pdoc has said *I can just manage your medication, but you can see me for therapy, too.*
He's said that he thinks my depression is more psychological than chemical. The last appointment he started asking me how it's going in therapy, how does she try to make me feel safe (I have major trust issues- with everybody...) Perhaps (he) should call T and talk about my trust issues and work together on helping me feel safe?
Assuming he really does have my best interest in mind, therapy and meds mangement with one person could be beneficial. I can see why your pdoc(s) have done both therapy and meds management and why mine keeps suggesting it.
For me, I need to keep seeing pdoc for meds and T for therapy, besides my insurance will run out on him long before I trust him enough to even get started. He is a Freudian psychoanalyst by the way, very comfy looking couch, I only chose him as a pdoc because he was covered under my old and new insurance. And my therapist had threatened to call 911 on me if I didn't see a pdoc for new meds. He kept me off the psych ward, so I guess that's meds management progress even if he did just up them again.
Poet
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