psychiatry advise

[cali7925]

I

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[worriedwell]

for what its worth...its flawed thinking to assume someone is a good clinician because they are chairman of a department. Chairmen become chairman due to their research, political savvy, and other things like their drive to try to get these positions rather than by how much their patient's like them. These things are very unrelated and I think it is a flaw in many people's thinking about how much they respect certain doctors. There are a ton of great doctors in clinical medicine who don't have the ambition to jump through all the political hoops to become a chairman. you have no reason to give this guy extra respect because he is the chairman. if he isn't doing a good job, let him know, or get a new doctor.

make sure though, your expectations on your doctor are not unreasonable...make sure you aren't just thinking "this guy is the chairman and he hasn't cured me, what gives?" dealing with mental illness is a chronic and sometimes difficult road that ultimately the burden lies on you and your doctor has to maintain a professional relationship with you. make sure you aren't expecting him to cry with you because you want him to feel your hurt. in fact, sometimes it is his job to frustrate some of those basic responses that you are looking for. but i'm not in the room with you guys, so i don't really know what is happening. you should bring it up and explore it. it might lead to growth on your part (and his).

 

[cali7925]

Wont

 

[50960]

You deserve better. Believe it.

 

[worriedwell]

I guess he might get pissed off, but he more likely would be embarrassed of this behavior. If he responds in a way that is aggressive or argumentative, then its time to get a new therapist. Don't rationalize why he is doing what he is doing by saying that its in the evening. It IS rude to roll your eyes in any situation to a patient. You are right, he isn't perfect and it depends how much this behavior has bothered you. If its an isolated thing, maybe it was a bad day. I don't know him or you and neither does anybody else here, so we can only go off of what you are perceiving. I sense that you definitely are having some combative feelings towards him. Maybe you are passive aggressive with him and then you don't feel you are adequately communicating with him and then you let it all brew when you are away from the office. All of these things may have implications in how you interact with the world (transference is a word that comes to mind). Its good to understand them and if he truly is a good therapist, he won't be pissed off at you and blow you off. It may be uncomfortable for you, but if it is a real dilemna for you...bring it up in a nice way. Its also very very possible that he just isn't a good therapist but he knows how to manage your medications well. If this is the case, consider seeing a psychologist, or another psychiatrist who has more skill at therapy. I'm not one to bash therapists when all I got is third party information, but you have to entertain the idea that you may not work together well. It ultimately is your choice and nobody else whether you want to see him or not.

best,
worriedwell

Wont he get pissed off if I challenge him about nodding off and his sometimes rude manners?

He does see me in the evening so maybe he is just exhausted and this is why when conversation gets slow he nods off.

he does help me address my main issues so i guess i dont have to be buddy buddy with him.

i still think its rude to roll your eyes at anyone who has been crying for the last forty minutes....perhaps he did it unconciously...he's not perfect but then again who is.

 

[worriedwell]

It just occurred to me that you are studying for step 1. Don't underestimate this stressor in your life. It may be contributing to frustration on your part that you may be overly sensitive to things that are occurring in your life. It doesn't change the fact that you should still bring it up in a nice way and have a talk about it. good luck!

best,
worriedwell

 

[psychgeek]

In your op you stated that your psychiatrist has nodded off MANY times during your sessions. Unless you are mistaken (maybe he thinks better with his eyes closed?), this is pretty inexcusable. There certainly could be transference and countertranference issues going on here, but that doesn't change the fact that he is not providing treatment to you when he is not conscious. Even if countertransferance is at work, I don't think falling asleep is an effective way of bringing it into the session. You most certainly have the right to confront him with this behavior and terminate with him if you are uncomfortable with his response. I'd also terminate with him if he ever falls asleep during another session.

 

[cali7925]

What

 

[sasevan]

Any advise on if i should switch docs? the idea makes me nervous. Is asking a doc to treat me with more respect and concern something I can really expect from the doctor patient relationship. I am very frustrated....are there any genuinely concerned docs out there.

Hi cali7925,
Congratulations on how much you have already accomplished, including having the wisdom and humility to obtain treatment for anxiety and depression.
I believe that all that you're going through can help you to grow as a person as well as a psychiatrist. To that end I would suggest the following:
1. Be aware that often times there's transference and countertransference in a psychotherapeutic relationship; this may well be what is happening here.
-Do you tend to avoid confrontation in other interpersonal relationships despite continuing to feel conflicted in them?
-Do you tend to stay in old dysfunctional relationships in order to avoid the risk of having to establish and maintain new, potentially functional, ones?
If you answer "yes" to either of these it may well be because of your current Axis I conditions or if it predates them it may well be because of some Axis II traits.
In either case, being assertive with your therapist may be very beneficial in you feeling less helpless, worthless, and/or hopeless or engaging less in apprehensive and avoidance behavior.
2. Also be aware that at times a clinician may be a very good pharmacotherapist but not such a good psychotherapist; from what you have described I believe your current therapist may be one of those.

I know it will be difficult to do so (and this may not yet be the proper moment for you) but please consider discussing your concerns with your treating psychiatrist. If he is even a mediocre psychotherapist he will appreciate you're being assertive and either work through the issues with you or offer to refer you to a more compatible therapist.
Best of luck; you'll be in my prayers.
Peace.

 

[cali7925]

Thank

 

[sasevan]

Thank you all for all your replies. I am actually a second year medical student. What are axis I and II? I do avoid conflict.

If I switch doctors, is my old doc obligated to send my files to my new doc. This could help my new doc help me with therapy faster. Also what is the difference between psychoanalytical and cognitive therapy. I do not know which is better for me. I have focused on talking about my past and how it has affected the way i think currently. I think this is the best way to go.

Thank you all so much.

Broadly speaking Axis I conditions are clinical syndromes caused by structural and/or functional biological problems that result in cognitive (e.g., delirium, dementia, psychosis), affective (e.g., mood, anxiety), and/or behavioral (e.g., substance abuse/dependence) disorders.
Axis II are personality traits caused by maladaptive psychological patterns that result in dysfunctional interpersonal relationships.
Psychoanalytical/psychodynamic therapies (Freudian, Jungian, Object Relations, Self-Psychology) focus on gaining insight and working through the unresolved (mostly) unconscious conflicts stemming from sexual and aggressive impulses as well as attachment, seperation, individuation and other developmental issues).
Cognitive/cognitive-behavioral therapies focus on identifying and correcting cognitive errors (personalizing, filtering, catastrophizing, etc) that are caused by/result in affective and behavioral problems.
Your current therapist will release your assessment results and treatment progress as per your consent.
Peace.

 

[worriedwell]

If its May of your second year, it strikes me as odd that your medical school hasn't given you a basic psychiatry course (or at least some classes). There are some required materials for step 1, and axis I and axis 2 is very basic info. So is transference and countertransference. Even if you aren't a medical student, just google any term and you'll get a million definitions. Either way, you should have the resources as a med student to look those things up. Please don't seek treatment over the internet...there are too many variables and too much that we don't know. We may be leading you totally in the wrong direction. You need to communicate with your psychiatrist or get a different one. Regardless, these issues are best addressed with a trained professional face to face. Even if your current psychiatrist is not working for you, he isn't going to let any embarrassment or anger at you get in the way of your treatment. He can't do anything bad to you, don't be afraid of him. Talk to him. If you are comfortable enough to cry with him, then you should be ok talking about these feelings that you are having now. I think its premature for us to be talking you into leaving him and for us to encourage all of these thoughts that you have questioning him. We may be doing you a disservice. You have to decide for yourself, but you are right, a years worth of treatment is significant and as such, talking to him should be the first step in trying to resolve some of these issues.

Thank you all for all your replies. I am actually a second year medical student. What are axis I and II? I do avoid conflict.

If I switch doctors, is my old doc obligated to send my files to my new doc. This could help my new doc help me with therapy faster. Also what is the difference between psychoanalytical and cognitive therapy. I do not know which is better for me. I have focused on talking about my past and how it has affected the way i think currently. I think this is the best way to go.

Thank you all so much.

 

[Anasazi23]

If its May of your second year, it strikes me as odd that your medical school hasn't given you a basic psychiatry course (or at least some classes). There are some required materials for step 1, and axis I and axis 2 is very basic info. So is transference and countertransference.

I had the exact same thought. Sounds weird. Know your axis designations for Step I. Remember mental ******ation goes on Axis II. You should (re) review First AID psychiatry section. Don't want to miss the easy points.

 

[lazure]

To the OP:
I agree with the suggestions to discuss your concerns with your current psychiatrist. If you do decide to see someone else for more therapy, don't be too concerned about having to describe your family's dynamics again. You may find yourself describing them more succinctly with a greater sense of emotional distance. Furthermore, describing the dynamics again to a qualified professional may help you see your own role and what you can change in your own behaviour towards your family members. As much as we want to, we can only change ourselves but not others.
Good Luck.