Psychologist vs psychiatrist …. Which is best

[Patches63]

Couple months ago my local Dr referred me to physiologist for CBT for PTSD with events going back over many decades.  As part of journaling I typed up a timeline showing yr of event, my age at the time and brief summary of event.  First 2 sessions with psychologist were complete taken up by going through the timeline and her asking questions.  3rd session I was already upset, couple days prior had been told by one of my friends herself and her hubby moving interstate before end of the year.  This information triggered my fears of abandonment with horrible nightmares of me being completely on my own.  Psychologist spent 3rd session trying to calm me down and talked about theory of how trauma affects the brain plus talked about flight, fright, freeze reactions.

local dr at recent appointment has doubled my dosage of anti depressants and said he thinks I will be better off being referred to a psychiatrist due to my PTSD.  When I asked local gp why he thinking about referring me to different therapist after such short period of time his reply was for me to discuss with my psychologist at next session, discuss with her and then have next review with local gp within a week of having next session with psychologist.

Im confused.  I don’t understand why about 7 weeks ago local dr referred me to psychologist and after having only seen psychologist for 3 sessions local dr now thinking psychiatrist is more appropriate.  

has anyone experienced similar?  Any thoughts or experiences regarding the different therapists for PTSD, OCD and associated anxiety?  

Patches

[mmMekitty]

Hello Patches

I'm not surprised you are confused. I would have expected if your GP is the one who thinks you would do better with a psychiatrist, then he ought to also be able to explain the reasons why. If the psychologist, (maybe), has been in contact with your GP & has asked torefer you on, then surely, they could have spoken to you about the idea first.

I have primarily seen psychiatrists over the years, because they first qualify as doctors before going on to do 5-6 years more to qualify as a specialist, i.e. as a psychiatrist. If I was on meds, they could prescribe & monitor me while on them. Having had extra training, they understand more about the meds than would a GP, or a psychologist (who cannot prescribe, anyway).

There are also more regulations around the practice of psychiatry than around psychology, too. Even so, I think there ought to be moreprotection & education for patients.

Psychiatrists, however, are more costly, even with the assistance of Medicare rebates & the safety net. It's extremely rare to find a private psychiatrist who will bulk bill without any gap to pay. & the public system, so I have heard, a patient seems not to be able to stay with a psychiatrist for long before having to see a different psychiatrist & beginning all over again.

For you to deal with what you need to deal with, it's very important to find someone who you feel you can begin to trust & feel a great sense of confidence in. That won't be easy & cannot happen with just a few sessions, not if you are anything like me.

Thhe first psychiatrist I saw, it took me two years to feel I could trust him enough to begin talking. Then six months later, he left for interstate, leaving me with a deep sense of abandonment & making it very much more difficult to trust the next one, who he had referred me to ... well, that was a big mistake he made ... long  story. But now I see someone I trust, can ask any question, which may or may not be answered.... & I feel somewhat like I can complain about his lack of response. It's  not easy, but I know that he might also be very supportive when I have most needed that.

I hope that helps.

Hugzies 

mmMekitty

[Patches63]

Thanks mmMeKitty.  
local dr told me to discuss with my psychologist if she feels I would be better working with a psychiatrist at my next session. Based on this I doesn’t appear there has been much, if any, communication between psychologist and local dr.

I feel comfortable talking with my psychologist with what we have gone over so far.  
during first session with one question she asked at the start it led me to mention I have IBS.  Psychologist immediately asked if I was happy to answer some questions about my IBS. Her questions gave indication she may have some knowledge in this area.

going through the timeline with the psychologist we talked a bit about each event.

Couple of events that happened when I was early teenager I got bit emotional about.  
all other events in the timeline there was no emotions when I talked about them.  I can see everything in my mind like I’m remembering a movie.  Lots of things in my past I’ve never felt comfortable enough to talk about including psychiatrist I saw for couple years after my mum died. Only things I remember about that psychiatrist are he placed me on meds and started weaning me off them whilst seeing him and that we talked about suicidal thoughts I had at that time.  Psychologist I’m currently seeing is first person I can think of who has said about gradually helping me deal with the events and assistance with dealing with triggers when they happen.

I know I’m quite hard on myself at times, doubt myself and question myself about did I do or say something wrong.  Psychologist last session briefly talked about these things plus told me some things to try to gradually retrain my brain and thought processes.

Patches

[mmMekitty]

Hello Patches

Sounds to me like you are feeling that you can work with your current psychologist. It doesn't hurt to talk  with them about what your GP said about seeing a psychiatrist, because it is still your choice - so long as she is happy to see you, of-course.

I sometimes have worries about if my PDr wants to see me, but he points out, if he didn't, he certainly doesn't have to. I surely do know, there are plenty of people who he could see if he or I decided not to continue my therapy with him.

It's a topic that makes me very uncomfortable. I have sometimes mentioned my fears about the possibility that I might or he might end the therapy. One day, he will retire, or maybe I do develop dementia to such a degree there is no reasonable wey we could communicate ,,. playing 'what if'...  the future is not set in stone, eh?

For now, I can appreciate what I have, having him as my PDr.

If you think you have found someone you feel comfortable enough with to begin to explore those areas which are difficult, then wouldn't be worth while telling your GP & your psychologist how you feel.

Maybe too, there is some fear in there, like when I even contemplate the idea of seeing someone else, that you will be left with no-one you can talk to, that all the searching for someone else would end up with no-one better, or worse yet, someone worse than what you have?

I know for me, it's a scary thought.  Maybe it's not the best reason for staying with my PDr, (& it's not the only anyway), but it has made me very aware of fears of being abandoned, & how 'attached ' I feel. that's another topic, too, which I'm dealing with.

Anyhow, those are some thoughts of mine. If you can relate to anything, I hope my thoughts have helped. 

Hugzies

mmMekitty

[Patches63]

mmMeKitty, way local dr spoke it sounded like I would only see one type of therapist.  Knowing that there can be waiting periods to see psychiatrist I didn’t want to be left without someone to talk with to get some help.  
fears …. Definitely. Fears that if starting with brand new therapist would be rehashing everything I went through during first 2 psychologist sessions, both left me emotionally drained.  Fears of going weeks, or months, of not getting any help, that I would reach a point I wouldn’t want to talk and would slowly spiral into oblivion.  Say local gp on Thursday, on saturday started feeling agitated and on edge, felt worse on Sunday. Today woke with SI thoughts and took me hours to get out of bed.  My cats are my saviours and know I would not follow through on my thoughts because of them.  Felt angry with myself for not thinking about my 2 furr babies and not fighting the dark thoughts.  This afternoon I did my safety plan and gave myself permission to do nothing but relax on the couch with the cats and play couple games on my iPad I enjoy.

knowing, if my psychologist feels will also help, that I can get help from both therapists has been a big relief and feeling physically exhausted.  Last couple weeks have become a nightowl being wide awake in early hrs of the morning and surviving on 3 or 4 hours sleep each night.

Patches

[Patches63]

With a brain that’s feeling foggy due to not much sleep, again, I’ve been trying to think back over entire last appointment with local gp.  

clearly remember him asking me how I’m feeling and telling him about symptoms I’m still struggling with.  Also told him areas where I was feeling better.  Clearly remembering him saying about double dosage of my meds.  Clearly remember him saying that he thinks I might be best seeing psychiatrist and for me to discuss with my psychologist at next session.  Everything after that sounded blurry and not clear.  Think he might have said something about cptsd but can’t be certain.

I’ve now been taking anti depressants for about 2months and don’t feel they are doing anything.  Have days where am feeling fairly good within myself, get things done including enjoying one of my hobbies.  Other days am fighting back tears or in tears.  Nightmares have stopped but semi dread going to bed and can’t get solid night sleep.  Can go to bed at 10pm and struggle to fully wake by 9am with feeling so tired some days.  Currently waiting to have initial appointment with rheumatologist, recent scan results of my lower spine saying severe arthritis in every lumber joint plus Tarlov cyst at base of my spine.  Thought of anyone doing anything with my spine terrifies me.

when I last saw local gp I was still having nightmare following recent trigger.  Am wondering if mix of mentioning the nightmares plus other symptoms is why local dr has mentioned possible referral to psychiatrist.  I drove home from doctors fighting back tears, went to bed when got home and cried myself to sleep.  Possibly due to fear of unknown or not having been given more information, don’t know.  Know I was feeling good that morning and in the afternoon felt was spiralling out of control into bottomless pit

Patches

[Eagle Ray]

Dear Patches,

From what you have said it sounds like you would prefer to stay with the psychologist. If the thought of changing from her to a psychiatrist is causing you a lot of distress, it suggests this is a pathway you intuitively don’t want to go down. If this is the case, it is absolutely in your power to choose to stay with the psychologist.

There could be a number of reasons the doctor suggested the psychiatrist. It might be that he or she feels a bit out of depth prescribing meds for you and maybe thinks a psychiatrist would know best in that area. Or possibly the symptoms you’ve presented with have made the GP think this way. I’m only guessing and can’t actually know. But I think the important thing to recognise is you are the consumer of health services and so you can actually choose what feels right for you.

If you think it would be good to get feedback from a psychiatrist as well, there is also the possibility of seeing one a couple of times to look at things like meds and see if they can be of help with that, but continue working with the current psychologist too. You could discuss this with your psychologist and let her know what the doctor was suggesting and how you are feeling about it.

 I think the most important thing is you want to build trust and a sense of safety and familiarity with whoever you work with. It’s often said that the nature/quality of the therapeutic relationship is the most important thing in the healing process, even more so than any methodologies used. I tried several psychologists and counsellors before I found my current psychologist, and I used my intuition in the end to find someone who was the right fit. I learned to trust myself about what feels right, rather than rely on recommendations or opinions from others, and things have worked out much better when I did that.

So check in with yourself as to how you feel intuitively and see if you can sense what feels right for you. You can let the psychologist know about how you’re feeling about this issue, and hopefully just discussing it with her will help.

Take care and try not to worry and see if you can ease into a sense of what would be the most supportive outcome for you.

[Eagle Ray]

Hi again Patches,

 I just thought I’d also mention that I think those of us with a complex trauma history often feel easily disempowered because of our past experiences. I know for years I felt like I didn’t have choices. If someone in a position of authority told me I should do something, such as a doctor, I thought I had to go along with it even if I felt differently inside. I am only recently really getting that I’m empowered to make choices that I can sense work best for me. So sometimes we can have strong reactions when someone suggests something we don’t feel at ease with, but we think we might have to go along with. What I’m gradually learning is I can discuss and negotiate things with people like doctors and I’m not in the vulnerable, disempowered position I always felt like I was since a child and when growing up. I used to collapse inwards and feel hopeless. I’m now understanding things can work differently. I can advocate for what I need and it’s really ok to do that. So I guess I’m just encouraging you to trust your intuition and listen to what the inner child in you most needs. Those of us with complex trauma often have an inner child we need to take care of, who didn’t receive the care that should ideally have been there growing up. I’m gradually learning now to care and protect that part of myself. So you can do that too and act in your own best interests. It’s absolutely appropriate to listen to the advice of others, but weigh it up internally too and then go with what you sense will help you.

[Patches63]

Thanks Eagle Ray for sharing that information plus suggestions.  I also am a person who follows my intuition a lot of the time.  I’ve only seen my psychologist 3 times so far but feel comfortable with her. During first 2 sessions I had no hesitation in expanding on summary timeline of events and answering her questions.  Whether me being numb and provide general details on majority of events as if summarising a movie I don’t know.  If it comes to providing in depth details of some events for which I don’t talk about to anyone, that might be a different situation.

only thing where I am feeling uncomfortable and nervy about is in first session she asked if I had suicide thoughts and told me if I did she would have to involve a third party.  On and off during the approx 15years I’ve had SI thoughts which have never gone more than initial thoughts.  Last couple weeks I’ve started having SI thoughts again. I live alone with 2 cats and am moving to lifestyle village just over a month.  I’m worried if I mention SI thoughts at all I will end up in psych ward, which is one of my fears.  When I was late teens to mid 20’s my dad spent few times in same psych ward and memories of those times are not the most pleasant.  During his first time in the psych ward my dad had a brain scan which showed large, old scarring from a stroke plus few mini strokes.  This was approx 4years after his first stroke which changed his behaviour from placid to violent

[Eagle Ray]

Dear Patches,

My understanding is a psychologist will only involve a third party if you indicate you plan to act on SI thoughts. Usually, if they are just the thoughts, they don’t involve a third party. So if you bring up SI thoughts you can also indicate you are not planning to act on them. I have had SI thoughts that I’ve been able to share with my psychologist and she hasn’t referred me to a third party. Likewise when phoning helplines I have been asked about SI thoughts. I told them they were present but that I didn’t plan to act on them. They thanked me for that because it clarified for them that I wasn’t in imminent danger and they didn’t have to take further action in that regard.

 I understand your feelings regarding the psych ward, especially with the experience of your Dad being there. It sounds like a lot was going on medically for your Dad that changed his behaviour. It would have been very stressful for you. 

It’s good you have been able to share the timeline of events. It’s ok if you were feeling numb when doing so and if telling it like it was a movie. That is very common with events that have been traumatic and your psychologist would most likely be very aware of and sensitive to that.

It does sound good that you feel comfortable with her. I think you gradually build trust working with them over time. There will be challenging times along the way as you process stuff and it can be quite a journey, but really worth it if you like and feel safe with the psychologist and you are overall progressing over time. Sometimes between sessions I have talked to someone on a helpline if something has come up I’m really struggling with. Most recently I called The Blue Knot Foundation who specialise in complex trauma and they were particularly helpful because they were sensitive to complex trauma issues. So know that there is help always there with the psychologist, helplines and here as well. You are not alone on your journey.

 I hope all is going well in organising the move to the lifestyle village. I’m sure it’s a very busy time. Take care of yourself and all the best to you and your fur babies.