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

[Patches63]

Eagle Ray, things about inner child and disempowered resonate with me.

reading your words I remembered being about 9yo, feeling sad, not understanding why I felt sad and being told by my parents to cheer up and that I was ok.  At times feel I’ve never fully come to terms with death of my uncle at the young age.  Having been controlled by my dad for 3 to 4 of my early teen years I find at times this overwhelm, this is when my brain seems to start to shut down.  I’m going to be attending online discussion about advocating soon through SANE which am looking forward to, know this is area I’m not good at.  At times feel like I’m still that child under 15 yo trying to understand what’s going on and failing, scared to say or do the wrong thing due to fear of repercussion.  Within last 4 years when seeing different dr at medical clinic I attend that 1) death is part of life which I needed to accept. 2) refused meds until I could prove I had attended x number counselling sessions 3) being placed on meds and given diagnosis PTSD. Still coming to terms with having been listened to and diagnosed

[mmMekitty]

Hi Patches, ER & everyone

ER has reminded me how I had been so quiet & not bold enough to ask questions or too afraid to not answer when someone asked me questions  - but not until.

I''m learning to speak up, too, in my own best interest, too, If I find something someone says confusing or I think I haven't really understood, or even forgot the first half while they are still saying the second half, I can tell them I'm having problems & ask them to repeat or explain. I still find it quite difficult to do.

Some people here have suggested writing a list to use when going to the GP, but I don't see any reason not to do the same for when seeing your psychologist. Not really practical for me, but maybe yu will find it helpful.

As ffor the question about if you have had suicidal thoughts or attempts, this is a question therapists have a duty of care to ask. If you ask her who the 'third party' would be, that might help you feel more comfortable. She would also be interested in knowing how you think about your thoughts, what you do when you have the thoughts, & be happy knowing you have never acted upon these thoughts. On BB, there is a 'Safety Plan' you could create & use to help you when the thoughts arise. Having that would also reassure her that you can keep yourself safe.

If you look in Mental Health Conditions, (where this thread is located), you can also find ''Suicidal Thoughts and Self Harm', & there is a thread there called, 'Do you have a safety plan'.

You could even work with your psychologist to set up your own Safety Plan. 

I think it's very unfortunate how things were for your father & that his behavioural changes had impacted you so much.I'm not sure if knowing.there was a biological reason for his aggression helps all that much, because knowing doesn't undo all that happened. It might help you have some compassion for him, & if you've been thinking you had done things wrong, then you can understand, I hope, that you did nothing wrong, & in a way you might find hard to credit, neither did he.

Never the less, woulds still need to be treated. You can assist in your own treatment.

I didn't think I hadd choices, power or anything, but now I know better. What I have said is true - you can do a lot to help yourself, Or as ER has mentioned, your own Little Patches.

You can always call BB Counsellors, or write here, anytime.

Hugzies

mmMekitty

[Eagle Ray]

Dear Patches,

 I really understand about feeling you are back in your child self. That has happened to me throughout life but I can feel my adult self is more able to manage now and take care of the vulnerable child. And gradually that child is feeling a bit less vulnerable and more confident in the world. With the right support and encouragement I feel your inner child can grow too and the adult part of you can nurture the child part, which is the internal self-nurturance that we were meant to develop growing up. I really get what you say about the brain shutting down. Mine has done that a lot and I’ve felt lost and disempowered because of it. But that can definitely shift and I can feel I’m getting stronger and it’s less likely to happen. And if it does happen I know how to be gentle with myself and know it will pass.

As you describe there can be such varied responses from medical practitioners. I could really relate to that first response you got. Three days after my Dad died I went to the GP to get a medical certificate for uni. The doctor thought I was seeing him about other symptoms I’d seen him for before, which later were diagnosed as an autoimmune disease. But he didn’t believe they were real and accused me of making them up. I explained I wasn’t even seeing him about that, that I was asking for a medical certificate following my Dad’s death, to be able to organise the funeral etc. He wrote it but then sent me out the door saying “death is a part of life.” The insensitivity and lack of attunement from some doctors is quite incredible. I’m so glad you were finally listened to and diagnosed. It’s the beginning of finally getting support. It’s wonderful you are participating in the discussion through SANE. There really are a variety of resources out there to help us.

Take care,

ER

[Eagle Ray]

Hello MK and Patches,

MK, I’m only just seeing your post now as I think it hadn’t appeared when I last posted. I’m glad you are sensing the choices and power you have too. I have been quiet for so long too and finally learning to find my voice and speak up. That’s a good idea to write a list for the psychologist. It can help as a prompt when discussing emotional topics. I know sometimes I get lost in the emotions or dissociate, so having something to remind me what I’m trying to communicate about is a good idea.

Hugzies to you and Patches

[Patches63]

Hi Eagle Ray,

big thanks for mentioning Blue Knot, I didn’t know about them.

I’ve been struggling emotionally last few days. 
phoned and spoke to one of their counsellor s today who was so patient and understanding.

she gently questioned couple of my beliefs which we talked about. All that subconscious stuff that stems from things that were verbally grilled into my head as a child.

Patches

[divine_inner_goddess]

Hi Patches63 (and hello Eagle Ray), 

I can understand your confusion about being referred to a psychiatrist when you are already seeing a psychologist. There is no reason why you can't see both. I see both, for very different purposes, for PTSD, depression and anxiety. It might be helpful to clarify their roles......

A psychiatrist is a doctor that specialises in prescribing medications for mental health conditions. They have much more specialised knowledge than a GP, especially when it comes to things like PTSD, nightmares, flashbacks. So think of it like the GP is referring you to a specialist, like referring you to a orthopedic doctor if you have knee problem and need further assessment or treatment. But medication alone will not "fix" PTSD, especially complex PTSD, but perhaps might help with stabilising and functioning better, if that makes sense. I see my psychiatrist for a medication review somewhere between 6 and 12 weeks, it's kind of like a check-in to see how things are going and how I am coping.  

A psychologist on the other hand, specialises in the therapy side of things. They are not doctors, but are trained in mental health assessment and therapy. Psychologists use lots of different strategies and tools to help people move through their difficulties. Usually the sessions are longer and more frequent. For example, I see my psychologist sometimes fortnightly, or 3 weekly or monthly depending on how I am going. So it's like seeing a physiotherapist on an ongoing basis to help correct the knee problem. It sounds like you are developing a good working relationship with your psychologist and building some trust which is so important. In complex PTSD I think trusting relationships are often lacking in a person's life. And a big part of the healing comes from developing a trusting and supportive relationship with the psychologist.  

In my experience, it can be difficult keeping everyone on the same page though, my GP, psychologist & psychiatrist. I'm learning to advocate for myself and what I need, even if their opinion differs. It is quite a process.  

About the SI - I can understand why you might be worried about disclosing to your psychologist. It is part of a psychologist's duty of care to explain to you the limits to confidentiality in the first session (for example the psychologist may need to tell someone if you are at risk of hurting yourself) - that's perfectly normal, so don't worry about that. It does not mean you are going to be locked up in a psych ward! They just have to tell you that at the first session because it's part of their ethical duty of care. It is ok to tell your psychologist about SI - it is their job to help you with that. 

I don't know if any of that helps. I hope sharing a bit of my experience makes things a little clearer for you. I can see others have shared lots of information as well. 

Take care, 

dig 

[divine_inner_goddess]

Hello again Patches, 

I am so glad you found Blue Knot. They are lovely. Such a great support. 

I also wanted to point out that CBT is a very common therapy that psychologists are trained in. CBT focuses on how you are thinking (cognitive), feeling, and behaving and how the three impact each other, kind of like a triangle. But, it can get very "heady", talking about thoughts and feelings, if you know what I mean. PTSD is a condition that impacts the body and brain. So, you may find that at some point in your journey, you may need something that is body-based. For me, I am just discovering this recently. Actually, it was Blue Knot that suggested to me to find a trauma-informed yoga class. I did that and I find the class is so gentle and nourishing for my nervous system which is what I need right now. And I am doing lots of reading about trauma and the brain. That's where I am at in my journey with complex PTSD. 

I guess my point is that you may need different things at different times. And as you progress along your journey, you may find you get to know more and more what it is that you need next. I guess you are just at the beginning of your recovery journey, so it can be overwhelming and confusing. As other people have said, your own gut instincts & intuition can guide you. From my experience, it's hard with complex PTSD because we have usually been taught to cut off from our gut instincts & intuition. But it sounds like you have a sense of what feels right for you, so that's good. 

Let us know how you go, 

dig

[Patches63]

Everyone uses different words to describe things.

not a good day today. Feeling physically and emotionally exhausted. Sleep deprived, don’t think I’ve got anymore tears can cry today.

dig, your analogy is wonderful and has different way to process.

the analogies are very close to one of my own physical health conditions.

I have couple things I specifically want to talk about with my psychologist

- actual action/s if I talk about SI

- complicated grief syndrome/order

will also talk with her about psychiatrist especially due to the understand provided by yourself and others in the form of their role regarding medication.

Through having a relative with RA I have a head knowledge that some times different meds need to be tried until one that works with the persons chemical make up is found. Medication that I’ve been on for approx 7 weeks by now don’t feel to be doing anything, or not much

Patches

[Patches63]

Hi dig,

I have already starting doing bits of reading about PTSD to try to learn more and get a better understanding of my most recently diagnosed health condition.  Similar to what I have done over time with my other medical conditions.  By nature I am curious about things, how they work, how one thing impacts on something else etc. over the years I’ve learnt the more knowledge I have about things that better chance I have to cope and deal with things.  I become wary and nervy about unknown, regardless what it is.

warped humour is something I was exposed to at an early from from my mums siblings and their mum.  I kept my warped humour growing up and was something I used to try to hide from everyone what my life was actually like.  Majority of this year my warped humour has given itself permission to take a break.  Due to some of my physical health conditions I am limited in things I can do.  Next month I have initial appointment with rheumatologist, appropriate discussion to have with her at some stage.  Thanks for the thoughts

Patches

[divine_inner_goddess]

Hi Patches, 

I'm sorry to hear that today is not a good day for you. It's understandable that you feel exhausted. Please go easy on yourself and take care of yourself. For me when I am having days like that I ditch everything else and go into self-care / nurturing mode. It might just be as simple as curling up under a cosy blanket on the couch. 

Sounds like a good plan for talking to the psychologist. And that's great you are doing a bit of reading about PTSD. It helps so much to be informed, doesn't it? 

I get what you mean about using humour to hide what your life is actually like. I have used humour a lot too, it's like a mask. I don't mean to, but it does hide what is really going on. Most people would have no idea that I struggle with my mental health. 

I hope it goes well with the rheumatologist. 

dig