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Your odd dosing has more to do with your axis 2 disorder than your axis 1.
I'm open to that and have inquired about it, but no one has seen fit to ascribe such a diagnosis to me, at least not to my knowledge. I understand it's possible to see something glaring and I won't deny anyone's reality, but there's also a unique and limited context to anonymously posting online. Given the nature of this forum to not proffer medical advice, I will defer to my own understanding of my situation and the manner it's been explained to me by those who know me. I'm sorry if the vignette I shared about how a person could end up an SSRI TID was in a grey area. Calling it a temper tantrum was the fastest way I could think to convey the situation. In reality, I can only say that one event followed another. I declined Paxil CR; I was told that if I was going to not take Paxil CR that I had to take Paxil three times a day.
I apologize I thought you had actually posted an axis 2 diagnoses you carried in the past.
No problem.
I completely disagree with this. It is one thing to not argue with patients about placebo effects which many of my patients have all the time or to maximize the placebo effect by reassuring patient that this medication is effective for intended target symptom, but quite another to intentionally mislead patient to use placebo effect as a treatment. Especially with a patient with dependent personality issues, it would seem that you would just be feeding into the pathology. Saying that you need to either use the placebo or add more drugs is a false choice scenario. There are other alternatives including psychological treatments that aren't deceptive.
Not making a point because I don't have a real opinion on it myself, but curious what you think about motivational interviewing or neurolinguistic programming (not the efficacy of NLP but the ethics)? Both of those, to me, seem to involve a level of omission of facts.
With NLP, I was thinking along the lines of mirrored speech patterns as being equivalent to the topic of placebo. Although I suppose any therapeutic technique you don't directly tell the client about could be deceptive. With MI, I was thinking about the same thing, the techniques used, and whether the client is aware that they are being engaged in MI or not. MI goes a bit further in that I'm not even sure if the client necessarily has agreed to work on a particular issue when a therapist engages MI with them on it. But like you said, I guess that's true for a lot of psychotherapy. Although, those ones stuck out at me as being less obvious. Empathy, direct suggestions, instructions on breathing, or instructions on how to do CBT, or even hypnosis are all more obvious interventions to me, and it's more clear what the therapist's opinion and intent is. I suppose how you do any of those things could involve techniques that aren't specifically mentioned.
I think what you are saying is when a patient is coming to me for help but they might be focusing on the wrong target. For example, patient presents with depression but I find out that substance use is probably the root cause or a major contributing factor. It is completely consistent with motivational interviewing technique for me to present that information/opinion. The patient will either agree or disagree and in MI, I wouldn't argue with them, but would work with patient to examine the evidence for and against that. I would be completely upfront during the whole process. Not sure where the deception would be. I am also upfront with all of my patients that it doesn't really matter what my opinion is as to what is causing problems in the patient's life, what matters more is their opinion. This tends to avoid the defensive pattern of intellectual debating that many patients are used to doing with everyone else in their life.
