Alliance with psychiatrist?

[Banned]

I know how important the therapeutic alliance is when you're working with a counsellor or therapist. I mean, you're spilling your entire guts to this person so it's really helpful that there's some level of connection and "likeability" between you.

But...when it comes to a psychiatrist, is this connection as necessary? Or necessary at all? Their primary function is to diagnose and treat (medicate)...so does one need to "like" their psychiatrist, per se? Or is it enough to "tolerate" the relationship?

I've met with "mine" once only, and haven't had an opportunity to really form any opinions on him. But I'm curious what might happen when/if I do.

 

[Domo]

I don't like my psychiatrist. My psychologist said i don't have to, we just need his brain :lol:

So in my opinion it's not exactly necessary (at least in my circumstances we have decided to deal with it)

I can expand on my point of view if you want me to.

---------- Post added at 11:58 PM ---------- Previous post was at 08:57 PM ----------

I also should have added that while i think it is not a necessity, it would be preferable to have someone you get along with.

I know i am somewhat hindered as i don't feel comfortable talking much and information is often not passed on that he needs to hear.

Eg. I would not be able to tell him i was hypomanic the other week. Which is obviously important for him to know. In this case my psychologist will speak to him, so he will raise it with me and it will break the ice a bit. Otherwise i wouldn't have said anything.

So, it really probably depends on the circumstances.

Hope that made sense.

 

[Retired]

Through my working career as a non medical professional I had the wonderful opportunity to know hundreds of psychiatrists as my clients. Most defied the stereotypical image many people have of physicians who choose that particular specialty, and most are are down to earth, compassionate and easily approachable, didactic and highly trained medical specialists.

As in all fields of work, and we see it in medicine as well, not all physicians, psychiatrists included, have the same approach to interacting with their patients. A lot has to do with their own personality, their training, even their ethnic background while some has to do with their own style of conducting their interviews in order to eleicit the information they need to form a diagnosis and treatmen plan.

I believe the bigger variable in how the professional relationship might develop has to do with the patient or client's perception of the interaction with the therapist. Because psychiatry requires interviews to get to the root of the patient's issues and concerns, and because these issues and concerns are often our deepest darkest secrets we would under ordinary circumstances never reveal to another living soul, by sharing these innermost thoughts and feelings with the psychiatrist, as lay people expect the physician to share in our grief, our anxiety, our fears and our delusions with the compassion of a new best friend.

Although people in the mental health field are generally compassionate and understanding, their goal is not to become our newest best buddy, but rather an objective consultant who has had training in just about every mental illness known today, using scientifically accepted tools, tests and criteria to reach a possible diagnosis based on the information being elicited from the patient/client.

In my non professional view, I feel the doctor's competence is more important that his/her charm, although I have known precious few people in this specialty who did not possess at least a minimum amount of personal charm to help make their patient feel at ease to be able to speak freely. The one's with limited social skills were usually working in labs having limited contact with patients anyway. IAC as a patient, you always have the right to request to be sen by someone else if the person assigned makes it impossible for you to feel at ease.

The most important criteria in the realtionship with one's therapist, I feel, is to be able to speak freely and comfortably, without sensing any judgement from the therapist. Secondly, there should be a plan set out early in the relationship as to what steps and measures will be done to help resolve your issues, what goal can be expected and in approximately what length of time. As the sessions progress, these goals and expectations may be modified, but I feel it is important to have a mutually agreed upon roadmap of what will take place, how you both intend to get there and what to expect at the end.

Developing a "professional friendship" with one's physician is a bonus, but a professional friendship should not be confused with a best buddy, out to dinner, go to the movies type of relationship, as the altter would jeopardize the professionalboundaries and objectivity required for effective, competent and ethical therapy.

 

[Daniel E.]

I think for many people the doctor-patient relationship, which includes likability and perceived competence, may help to some degree when it comes to medication compliance, e.g.

[FONT=verdana, arial, helvetica, sans-serif]One of the ironies of medical care in the United States at the beginning of the 21st century is that patient satisfaction often is low despite major improvements in medical technology and therapeutics...

[/FONT][FONT=verdana, arial, helvetica, sans-serif]A particularly painful aspect of this irony is that it now occurs frequently even in psychiatry, the specialty that should be most concerned with understanding and utilizing the patient-physician relationship for the patient's benefit.

[/FONT] The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness - JAMA

Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance.

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

OTOH, the amount of time allocated for medication checks (20 minutes vs. 5 minutes) is probably more important than the doctor's personality:

The time spent allowing the patient to fully explain his/her concern determines the physician's ability to show concern, empathy and likeability.

Pearls: Malpractice Prevention

 

[Banned]

Thanks, guys.

I have my second appointment with him on Monday. I'm proposing a med change and don't really anticipate needing to see him very frequently, I don't think. I'm not sure after this if I go back to my regular doctor to get med refills or back to him. He was very accommodating at my last appointment when I told him I was completely out of meds - he wrote me a prescription to get me through until my family doctor got back. I'm not sure how much "monitoring" these meds need, or if once he's prescribed them (assuming he agrees it's a good route to go) my family doc will be comfortable refilling them.

I guess I will learn as I go.

 

[SoSo]

I had a psychiatrist that I went to 3 times and each time he nodded off to sleep. So, the third time, I got up, said I was sorry to bore him, walked out and never went back. Then, I got another psychiatrist that I did form a good patient/doctor relationship with. I know that really helped me a lot. I hope all goes well with your appointments. As you said, we learn as we go and hopefully, the journey is worthwhile.
SoSo

 

[Banned]

Wow SoSo, good for you for walking out. I honestly don't know if I could do that!!

I had a therapist who used to fall asleep on me all the time, and I'd just wait for him to wake up, but I'd be seething inside. I wish I'd had the guts to walk out because it certainly crossed my mind more than once!

Anyway, yup, I'll see how things go on Monday.

 

[Murray]

Wow, I can't imagine my therapist falling asleep during session, I would feel horrible. Mine yawns a lot, but never sleeps.

 

[Banned]

I was impressed with the attention level of my psychiatrist at the first visit. Granted he was gathering alot of information, but he seemed engaged in the process and interested in helping me. He also asked about the gash on my face (I had been bitten by a Rottweiller and had four stitches just the day prior) and I told him what it was from. He looked horrified and told me he has a Rottweiller and assured me that they're not all like that, so he attempted to connect wtih me on some level as well which was good.

 

[SoSo]

Ha, that psychiatrist I mentioned actually snored, good grief. I actually found it amusing the first time and sat there talking a bunch of nonsense just to see if he actually was asleep, the snores gave him away. Glad your P is more involved. Sorry to hear about the dog bite and stitches. Had my face chewed up when I was 3 by my fathers dog and I remember it. Hope it heals well and all the best Monday.
SoSo