Tag Archives: Psychiatrist

What about our care?

Photo credit:  seiuhealthcare775nw

Last week I started a discussion as a result of some news articles I read.

The first article dealt with Dr. Donald Levin who felt that he could not provide both talk-therapy and medical treatment anymore.  Dinah Miller, MD, however, maintains the view that it is essential to receive both treatments from one qualified person.  John M Grohol PsyD introduced the thought that nowadays clinical psychologists,  amongst other mental health workers,  are much better trained in the area of psychotherapy than psychiatrists.

This led me to ask two questions:

1)         What to think of the appearance of other mental health workers providing various types of (talk-)therapy?

2)         Is it really better to be treated by one doctor providing talk-therapy as well as medical treatment?

One commenter, A. Karmin, wrote:

Since there are so many approaches to psych, it’s an asset to have various providers to turn to. If one has a negative experience it does not mean they should stop all treatment, rather they need to find a new provider. Kinda like if you go to a bad restaurant, you don’t stop eating, you just find another place to dine. The bottom line is to find the kind of treatment that suits your taste.

I love how he relates it to a dining experience!  Instead of staying with a health care provider who is not to our taste,  be it a p-doc,  counselor or some other therapist,  we should find one that is.  For this to happen we first need to know what care we need and want,  before we can go looking for it.

This can be as diverse as our food taste,  as Mommylebron’s comment shows:

I have an adult friend who sees a p-doc who is on charge of both her meds and therapy. However, in our case I feel that having one doctor who could cover both areas effectively would make it easier for me to keep up with my daughter’s treatment plan.

Since she is a mom to several children,  having  to go to different doctors for treatment is simply not an option.  So,  she needs to look for a p-doc providing both med and talk therapy with whom she and her daughter feel comfortable.  Unfortunately,  this can be quite a challenge…

Melody observes the following:

I believe it is imperative to have a level of continuity of care between the medication management and the therapeutic treatment to retrain the brain.

I wholeheartedly agree with this statement.  Oftentimes,  since diagnosis tends to happen during a crisis,  the medication treatment is started first.  Once the crisis  has passed or is under control there is room to start a form of therapeutic treatment.

My own care is divided between my counselor who resides in America and my p-doc and GP who live here in the Netherlands.  This is a pretty unusual situation and something the Dutch mental health system couldn’t deal too well with.

My counselor and I were already working together for over three years when I unexpectedly ended up back in my home country.  Through telephone and mostly Skype,  we continue our sessions as I was not willing to give up what we had built up over that time.  I am very grateful that it works very well for me!

I opted out of the Dutch mental health care system and found myself a psychiatrist in private practice,  specialized in mood disorders amongst other things.  My GP happens to know him and both of them have short links with the mental health care system.  Which is a reassuring thought!

With thanks to my commentors 😉


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A heated discussion?

A heated discussion

Photo credit: ktylerconk

About a week ago,  while catching up on my reading,  I came across an interview of Dr Donald Levin by Gardiner Harris.  This extensive interview appeared in the  New York Times on March 5.  The title stated that talk-therapy doesn’t pay  (as in,  insurance doesn’t cover those costs),  so psychiatrists (have to) turn to drug treatment instead.

The title is somewhat misleading as the article mainly revolves around Dr. Donald Levin’s working life.  He started private practice back in 1972, but worked in hospitals from 1985 till 2000,  before starting his private practice again.

As to be expected with the relapse of time, the practice of psychiatry had changed.  For Dr. Donald Levin it meant that where he previously provided medical ánd talk therapy,  he slowly turned solely to dealing with drug treatment.  It appears to me that he blames the system for this situation.

However,  there are still many psychiatrists offering both treatments.  One of them is Dinah Millar M.D.,  who wrote a response to this interview in Psychology Today (March 7),  that psychotherapy and psychiatry are still the best of partners.  She maintains the view that patients get the best of care when only one doctor is involved providing both treatments.

So,  maybe it is more about doing what you believe in,  without letting the amount of earnings stand in the way?

It is unfortunate for all medical doctors that the world of insurance has so much to say about which treatment receives coverage.  I consider it worse though,  for us,  as it greatly influences the choices we can make while  ‘shopping’  for the care we need.

John M Grohol PsyD,  the CEO and founder of the Psych Central website,  expresses in his blog that nowadays clinical psychologists,  amongst other mental health workers,  are much better trained in the area of psychotherapy than psychiatrists.

It is a given that time brings change.  It can be debated,  however,  if all changes are good changes.

Perhaps one of the biggest changes within psychiatry is the appearance of other mental health givers providing different varieties of (talk-)therapy.  Thus the ‘old’ idea that (psycho)therapy is only connected with psychiatrists is – well,  old!

What we should ask ourselves,  is what the consequences of this change are for us and how it influences the care we need and receive.

The question is,  in my opinion,  twofold:

*   What to think of the appearance of other mental health workers providing various types of (talk-)therapy?

*   Is it really better to be treated by one doctor providing talk-therapy as well as medical treatment?

I really like to know what you think!

Please,  share in the comment section or via the  ‘contact me’  page in the left hand top corner.  Thank you!

This post has been followed up with What about our care?

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10 things about my Bipolar Disorder you didn’t know

1)     I am not sick!  Nor am I any more crazy than you!  (Are you sure? Hmm, actually, yeah.)  My brain might function differently than yours,  but other than that,  I am just… me.

2)     I can be sick, and/or indisposed,  at times,  when for one reason or another it is too hard for me to handle my mood swings or I end up in a particular nasty or difficult mood.

3)     Bipolar Disorder does not define who I am.  There is a whole lot more to me than swinging along on my mood-swing.

4)     There is so much to learn from all my moods,  as I experience a whole range of emotions that ‘normal’ people do not.  Yes, it’s definitely a tough road to deal with it on a consistent basis,  but hey,  is your life so easy-peasy?

5)     I don’t need to be ‘cured’ – I was born this way and I have not known anything different.  I might not recognize myself anymore…  Now, that is a scary thought!

6)     Even though I hate my meds and I’d like to chuck ’em out of the window from time-to-time,  I am med-compliant.   The consequences of doing so keep me from doing it.  No visit to the p-ward for me,  if I can help it,  thank you very much!

7)     Having regular consults with a psychiatrist doesn’t mean I am crazy.  The stigma it carries unfortunately doesn’t stick to me.  I like my guy!

8)     Because I have ‘talk-therapy’,  it has helped me deal with a lot of ugly stuff in my past,  I’m getting to know my real self and I am learning an awful lot in the process.  I just love my counselor!  (And no,  you can’t have his number,  I have sharing-issues 🙂 )

9)     It’s really neat what I can accomplish when I am hypo manic!  Of course,  I need to keep it in check and thankfully I have some peeps helping me with that.  And some meds  (which I truly hate!)  to bring me down when necessary.

10) It’s okay to be me.  Well,  sorta.  Am on my way to self-acceptance.  Which includes ALL of me,  not just my ‘Bipolar-side’.

Disclaimer: Please,  note that this list reflects only me,  my view on & my experience with my Bipolar (Disorder) traits.
Also,  I have had 5 terrible,  difficult,  excruciating years behind me that brought me to this place with the help of some very important peeps.   This is how I see it right now,  which is subject to change 🙂

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Bipolar Disorder: Peeps that are important

P-doc (BD talk for psychiatrist)

(S)He is important.  I wouldn’t go with any other type of mental health doctor or whatever names they happen to carry.  If possible of course.  I am aware that in the States the health care system and health insurance work differently than here.  My insurance allows me to choose my p-doc,  lucky me.

I even switched p-docs because I found the one I had not capable of dealing with my assertiveness.  And p-doc’s expertise – hm – not too experienced with mood disorders.  Now I have an excellent p-doc,  easy enough because I selected him on his expertise and willingness to work with me on my terms.  (Which is a co-operation in case you were wondering.)

Counselor

To me,  my counselor is vitally important as well.  In my humble opinion, meds are never enough when dealing with psychiatric illnesses.

The reason being,  that counseling or talk-therapy teaches you:

  • what our symptoms look like;
  • how to recognize our symptoms when they arise;
  • to deal with our symptoms to the best of our ability;
  • to learn about the things that can trigger our episodes;
  • to deal with any emotional luggage we are carrying around that     hinders our well-being;
  • to deal with trauma’s we might have;
  • to lead a healthier life.

It provides us with the opportunity to:

  • share our highs and lows;
  • be totally upfront about our functioning or lack of it;
  •  receive support from a professional who will never condemn or judge us;
  • have somebody who is always ‘on our side’ as (s)he has our best interests at heart.

It took me a long time to learn to trust my counselor,  but,  boy,  what a blessing once I could!  Many times he has been a rock in my ever-changing world.  This was especially true since I moved around a lot as I didn’t have my own place.  My weekly appointments with him have given me a steadiness I desperately needed.

Also,  what I like very much about my counselor is his approach of BD and our emotions in general.  BD is not something we are a victim of.  Meaning that we don’t have to sit around and wait for the next episode and survive it the best we can.  There is more to it,  thankfully.  As we learn to recognize our symptoms and triggers,  we can also learn how to better deal with them.  This way,  we can influence what happens once we face a trigger or we feel an episode lurking / starting.

I am aware that emotions do trump and sometimes we  just have to ride out the storm.  Sometimes what happens can be way too much for us to handle.  But that is when we turn to our p-doc and counselor.  And to our support network.

Support network
We need more than our p-doc and counselor.  People around us who are close to us and recognize our mood swings are so important to have.  There are three good friends that know exactly what mood I am in when they talk to me.  Even over the phone.  We have the kind of friendship that allows them to be up front with me,  question and challenge me.

They will ask questions like:  ‘do you think that is wise?’,  ‘should you really do this?’,  ‘I think you are doing too much (or too little)’,  ‘isn’t it time to think about coming down from your hypomanic?’,  ‘how is your sleeping going?’,  ‘you can come and stay with us any time,  you know that,  don’t you?’.

Depending on the situation,  I do or do not like those questions.  It is down right irritating at times.  But at the same time I am so grateful that those friends are in my life!!  Because there will be times when they recognize an episode earlier than I do.  At times they will keep tabs on me,  when life is not going well for me.  At times they are very practical.  Like coming over when I am severely depressed and getting my house in order.  Or letting me come and stay at their house and taking care of me.  Precious,  folks,  precious!!

So I would advise you to have people like that around you.  To allow them to ask questions, challenge you,  take care of you.  It’s not an easy task,  for them or for you.  But it will allow you to live your life to the fullest,  knowing there is a safety net when you fall.  Even more than that:  it is designed to prevent you from making the fall.  Actually,  even more than that:  to keep functioning to the best of your ability.

Other interesting posts:

What is Bipolar Disorder?

Symptoms

Medical treatment

Why mood charting?

Mood charting revisited

How to help people with a mental illness

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