phychiatrist and therapy

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medved
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   Posted 3/22/2012 10:26 AM (GMT -6)   
Do most people see a psychiatrist for medical management and a separate person (counsellor, psychologist, etc.) for therapy?  Or just have the psychiatrist do both?  (Right now I am seeking psychiatrist only -- just started a couple of weeks ago -- I am inclined to keep it all with one person, but just wondering what the usual practice is).  Thanks!

It's Genetic
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   Posted 3/22/2012 10:51 AM (GMT -6)   
It's a psychiatrist's choice, medved.

Some prescribe and do psychotherapy; others prescribe and turn the patient over to counselors (often on his staff) for psychotherapy.

I don't think you could say that there is a usual practice, although I suspect that in major metropolitan areas, psychiatrists might choose to medicate and refer the counseling to their staff who are qualified.

It's Genetic

medved
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   Posted 3/22/2012 11:12 AM (GMT -6)   
Thanks IG. My psychiatrist does not have any staff. Not even a nurse or a secretary. Just an answering service that gets messages to him. Low overhead operation! So, if he "referred me out" for therapy/counseling, it would have to be to some unrelated person. He has not mentioned any such thing, thus far. So I was just wondering what the "norm" is, if there is one. I have read some articles suggesting that, increasingly, psychiatrists are interested in psychopharmacology more than therapy. But I suppose, as you suggest, that is not uniform. For me, I would prefer to stick with one person. I just don't feel like getting into the whole story with someone else...

It's Genetic
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   Posted 3/22/2012 11:16 AM (GMT -6)   
I prefer that route, too, medved, it just seems more personal when one person is handling it all. It may be a bit more expensive that way, but I like it, as you do.

It's Genetic

getting by
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   Posted 3/22/2012 2:00 PM (GMT -6)   
I see a psychiatrist if I need a med adjustment or just to touch base now and then, but his nurse is my psychologist. It works out really well, they are in the same office. But my sessions with the psychologist are just about an hour, where my appointment with the psychiatrist is only about 20 minutes.

I have understood the norm, so to speak, is the psychiatrist prescribes meds and the psychologist counsels. But that is just what I have experienced so far. I am glad mine are on the same team because they know what eachother are doing.

I am glad that your way is working for you. I understand where it would be better the way you have it. But my psychiatrist is mind and body and wanted me to see a therapist also.

Have a great day...

Hugs, Karen
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It's Genetic
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   Posted 3/22/2012 4:08 PM (GMT -6)   
I've been sitting here trying to decide why having a psychiatrist prescribe meds and a counselor do the psychotherapy work is considered the "norm".

In my years of exposure to psychiatrists, only one has ever been one to prescribe, while his staff did the psychotherapy. My conclusion regarding that one is that it was extremely expensive to have a psychiatrist spend an hour with a patient, then spend additional time prescribing.

Maybe it's cheaper for the client to have "counseling" rather than to have a psychotherapist who covers the client in regard to medication and psychotherapy. It may also have to do with changes in the way psychiatrists are charging now, particularly relative to their dislike of Medicare and some insurance methods required for filing.

Just paying once on a cash basis for each visit is what many here prefer, not bothering with the paper work for government plans, etc. It was government changes that altered some psychiatrists' methods of doing their work.

Besides, all one has to do is to report payments on income tax filings for medical deductions, and if one can get less expensive care with a counselor and pay much more just for meds prescribed, that makes sense, too.
 
Still, all in all, I prefer the care of a licensed psychiatrist.  I just
feel that I'm in the best hands available (if the personalities fit).
I can imagine that medved senses that,too.

It's Genetic


Post Edited (It's Genetic) : 3/22/2012 4:13:48 PM (GMT-6)


medved
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   Posted 3/22/2012 5:12 PM (GMT -6)   
My guess is that the separation that sometimes exists between psychiatrists and other non-MD therapists might have something to do with:

(1) reimbursement rates for medical management versus therapy (psychiatrist might make more money by doing a lot of medical management rather than longer therapy appointments); and

(2) cheaper for patient to have therapy/counselling from a non-MD and see psychiatrist only for those things that are essential (prescribing, etc.).

But I don't know that for a fact. It appears to me that my psychiatrist will do both -- at least for now. He charges a good amount of money and does not accept insurance. But I am very motivated to get well and willing to spend money to accomplish that.

getting by
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   Posted 3/22/2012 5:38 PM (GMT -6)   
The psychiatrist is much more expensive than the psychologist. My insurance wont let me see both on the same day. My psychologist gets my scripts for me from the psychiatrist.

Then I only see him occasionally. But my psychologist can call some of my meds in when I need. It depends what the prescription is. What class drug it is.

I am happy that you both have a good support system. That is so important.

Hugs, Karen
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No Worries!
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   Posted 3/24/2012 11:38 PM (GMT -6)   
Humm, I have been waiting for almost two months to see a psychiatrist and I still have to wait until May 11!!

I saw a 'counselor' once, but she flat out told me she couldn't help me. All she did was listen to my story, validate my feelings and send me packing. She gave me her email address, but never returned my email. I am on two different anti-depressant meds that my PCP and PM doctors have prescribed. One is for depression and the other is for both depression and pain. I need a psychiatrist who can take over my depression meds and give me some small measure of hope! A psychiatrist should be able to give me guidance in how to better deal with my anger, fear and major depression. I can't believe how long it's taking...

I'm slowly drifting away from reality. This isn't real, this can't be my life? Bad things don't keep happening to good people! What did I do? Why am I being punished? Its not fair. What's the purpose? How much more can I take? When is it going to end? There coming for me, I can hear their foot steps. I won't go quietly, they're going to hurt me! I want it to...I need it to...I wish it would STOP!

medved
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   Posted 3/26/2012 4:34 PM (GMT -6)   
No Worries --

Why is it that you need to wait until May 11th to see a psychiatrist?

Maybe you can call the psychiatrist's office and tell them that it is very important for you to see the psychiatrist soon, and could the doctor please make time for you. It might not work, but it seems to me it would be worth a try. Maybe they would squeeze you in for an early morning or late evening appointment.

I agree with your observation that when you see a psychiatrist, he (or she) should be able to help you get on the right track. Hang in there, my friend.

Best wishes, Medved

Badmood
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   Posted 3/28/2012 7:08 AM (GMT -6)   
I normally use phone therapy...so i don't feel even more depressed or considering myself as a weirdo during the real session in the therapist's room..i found few articles and researches telling that phone therapy helps with the same efficiency and some advices. here is an article. maybe it will help you to make your choice www.therapy-now.net/blogs/5

medved
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   Posted 3/28/2012 9:20 AM (GMT -6)   
Interesting idea -- phone therapy. I thought I would find "live" therapy awkward, never having done it before. But I don't. I know I need it and I do not find it nearly as uncomfortable as I thought I might. I do find the 45 minute length a bit too short. It is hard to really delve into issues in detail in such a short time frame -- particularly when a part of the time is spent with "medical management" issues. I would like two hour sessions, to accelerate progress. I am sort of impatient in that way.

No Worries!
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   Posted 3/28/2012 8:47 PM (GMT -6)   
Medved! I totally agree with you regarding the time issue. It's too bad they make appts. so short and then include the medicine discussion time. I did try to find another psychologist, but I was told they are no longer taking new patients! My depression has gotten the better of me today and I felt completely drained of energy. I went to my Orthopedic doctor without showering or shaving...I just didn't care and besides I didn't have the energy to do it. I looked exactly like I felt. I really need to speak with a psychologist ASAP!

Of course I am not in enough of a hurry as to use a phone therapist. I know Badmood that you said it was Helping you. I just picture someone on the other end of the phone ironing their clothes or playing video games as you talk and spill your guts out. I did speak with someone over the phone, but I felt awkward and just couldn't say what I felt. If I had someone who I could look directly at and connect with, then I am more likely to say what I need to say. I just couldn't bounce around from one counselor to another. I want the same person where we can build a relationship with and someone I feel I can trust.

I am so close to just walking into the ER and demanding to speak with a Psychologist! I have my first appt. with a Psychologist scheduled for May 11th, but I don't think I can wait anymore...

getting by
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   Posted 3/29/2012 5:20 AM (GMT -6)   
Get on a cancelation list so maybe you can get an appt sooner.

Hugs, Karen
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   Posted 3/30/2012 12:11 AM (GMT -6)   
I can't wait until May 11 th to see a psychologist, so I finally found a place where I can see a psychiatrist. My appointment is for next Friday. Unfortunately that's when my wife is off work. She doesn't know about the appt. yet and she is totally against me seeing a shrink. Don't worry, I'm going no matter what. She can go shopping or whatever for an hour.

Why is she so against it? Good question and I have no idea except that for her it's a sign of weakness? I've tried to find out why she is opposed to me seeking treatment and all she says is that I don't need any help...I'm fine. Well, she doesn't see me during the day time when she's at work. She's stubborn and there is no way to change her mind and I'm not going to waste my time trying to. I'm just going to focus on myself. I need some direction in my life and I need to learn how to control The anger I harbor for the person who ruined my life.

Charles

getting by
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   Posted 3/30/2012 6:14 AM (GMT -6)   
Hi Charles,

You need to let go of the anger. It just keeps us in a slump. Deal with it with your therapist and psychiatrist. I am glad that you are going whether your wife likes it or not. She has no clue as to what is going on inside your head. Remember that. She may not be depressed and doesn't understand. Educate her if you need to.

I hope you feel better soon.

Hugs, Karen
Moderator-Depression and fibromyalgia


fibromyalgia, Chronic fatigue, depression, allergies

No Worries!
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   Posted 3/30/2012 7:42 PM (GMT -6)   
Thanks again Karen for your kind words and encouragement. I've been struggling for a long time with trying to cope with my physical disabilities as well as my financial independence from my wife. It's like she makes me ask her several times (beg) for enough money to cover my bills. She knows I will get a big check once I win my Worker's comp case and will repay her. It's so stressful having to deal with my chronic pain and isolation as well as my mounting medical bills.

Right now my wife's health insurance is covering my medical bills and I still must pay the co-pays for each visit. A few weeks ago my doctor ordered blood work on me. I made sure that the doctor was in-network with my insurance company. Before I went and had my blood drawn at a lab, I also made sure the lab was in-network. I just received a EOB from my insurance company stating that the majority of the blood work done on me was not covered by them. Therefore the insurance company pays $257.00 and I must pay the remaining $1,837.89 in lab fees.

This is just another example of how the medical system screws us over. My wife is paying a steep monthly premium for this health msurance and they only cover a tiny portion? My mistake was that I didn't check exactly what the blood work was for or what lab tests needed to be done and what the health insurance would cover. This is another very expensive mistake. Before my work "accident" I was slowly building my credit back up. Now I have a few medical bills that have gone to collections! I even called them up and tried to setup a monthly payment plan, but they demanded I pay a certain percentage that was way too high for me. So rather than collect some of the money over a period of time they sent the bill to collections demanding payment in full. They know I am disabled and have no income yet.

Bottom line, I'm in a ton of pain every day, I spend 90% of my time alone, I feel completely useless and I have a mounting medical debt. I just couldn't afford to keep my cup half full...

No Worries!
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   Posted 3/30/2012 7:59 PM (GMT -6)   
I read my second to last post and realized I had it backwards. I am seeing a Psychologist next Friday until I can see a Psychiatrist. The lace where I will start seeing a Psychologist won't have another Psychiatrist until sometime in July. However I still have my May 11th appt. with a Psychiatrist in another practice, but I might cancel the appt., but not until I see this Psychologist next Friday. If I feel we have a possible connection I think I can deal until they hire another Psychiatrist at there practice. Is anyone as confused as I am?

I did see a "counselor" once, but she flat out said she couldn't help me other than to listen to me vent. At the end she gave me her work email address and welcomed me to send her an email later to let her know what I have decided. I wrote her an email and explained how thankful I was for our time together, but that I felt I really needed the services of a Psychiatrist. I mentioned that I needed more than someone who would validate my feelings and tell me it's okay to feel how I feel. I asked her to please see if there was an available appt. with one of the Psychiatrists and to let me know she received the email. She never bothered to return my email and I'm 99% sure she receive it.

I am sorry if I say things more than once. My memory is shot, which is a whole other issue with my wife and me...

Charles

Serenitee
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   Posted 3/31/2012 12:19 AM (GMT -6)   
Hi Medved,
 
I know when i was in Outpatient Treatment most of the patients had both. They saw their Psych 1-time a month 2 check how meds were working...Then they saw a Psychologist 2 help them with their more struggles on their personal stuff...Past or Present.
 
However, for me, my first dealings ever with Mental Health were 19-mths ago. I had no choice cuz the police had put me on a lockdown on the psych ward for a couple weeks. Where i had 2 see Psych Dr. everyday. When they released me they had set me up with Psych & a Psychologist. 
 
I went thru 2-psychologists & i didn't care for them. So my Psych took over with my entire case. I currently see both again cuz i'm in DBT-Outpatient & U have 2 have a DBT-Psychologist weekly.
 
I think its just what U prefer. If U like ur Psych & their willing 2 take Ur entire Mental Health stuff then U can do that. Which is easier seeing only one.
 
Good Luck,
Serenitee

No Worries!
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   Posted 3/31/2012 10:55 AM (GMT -6)   
Serenitee, good advice...however there seems to be a poor supply of psychiatrist around where I live, so if I don't lime him/her I'm kinda stuck. Right now my PCP is giving me medication for my depression, but its not working. He is not too comfortable playing with the dosage and prefer I see a shrink. I agree with him, I just want it volunteery and not a forced visit VIA the police.

I have to pay a $20.00 co-pay each time I see a psychologist and a psychiatrist and my PCP. When I have no income these visits add up quickly! It's enough to make a crazy person insane! Haha

Serenitee I hope you have found the tight team of experts that you like and are comfortable with and you feel better.

Charles
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