Psychiatrists

[Eunoia]

If you're working w/ a psychiatrist is s/he inevitably going to put you on some kind of medication just b/c they're a psychiatrist (assuming that meds have been shown to help w/ the problem)? Can you ever really tell a psychatrist that you don't want to take meds if they would prefer you do? Besides from a psychiatrist being able to prescribe medication (and maybe insurance reasons) is there any other benefit why they would be more suitable as opposed to a psychologist?

 

[David Baxter PhD]

There are good, better, and bad psychiatrists just as with any other profession, Eunoia. Some are very good therapists who respect and listen to their patients. Some do little except prescribe medication and get annoyed if you question their descisions.

There are also, of course, good, better, ad bad psychologists.

I would say that in general psychiatrists tend to be more medication oriented while psychologists tend to be more eclectic or holistic.

 

[kaht]

My psychiatrist draws more heavily on psychodynamic psychotherapy than his prescription pad I know he may be the exception rather than the rule though. Therapy is a contract that should be based on mutuality. Any psychiatrist worth their salt will listen to your views and your needs for your own body and mental health and take them into consideration. I'll actually be the one suggesting tonight that I go onto some sort of medication. Psychotherapy has been effective for me, but with suicidal thoughts starting to creep back into the mix, it could be time to look at the brain chemistry factor.

As to whether psychiatrists are better than psychologists, I think David made a very astute observation on that point. Personally, I went with a psychiatrist because their fees attract a Medicare rebate here in Australia, while psychologists do not. Plus, I don't believe our minds operate in isolation from our brain/body, so I like that he has the gestalt...the whole picture on my health.

 

[David Baxter PhD]

I don't believe our minds operate in isolation from our brain/body, so I like that he has the gestalt...the whole picture on my health.

I think you'll find that many psychologists also take a holistic approach to health - physical and mental health are almost always linked.

 

[kaht]

physical and mental health are almost always linked.

Agreed! That's why I'm choosing a PhD in Clinical Neuropsychology...it's about as much of the 'physical' as you can get that's relevant to psychological functioning without studying Medicine. I've just never had a psychologist check my blood pressure during highly stressful periods, whereas my psychiatrist does. It's convenient not having to go see a separate health provider for those physical symptoms that are directly linked to the psychological issues.

 

[David Baxter PhD]

I check my own blood pressure )

 

[Eunoia]

just as a side note my clinical prof complains a lot that no clinical textbook has ever written about or included a chapter on physiology, even though physiological measurements can be and are of great value to the "cinical picture" as a whole. But I guess not every therapist agrees w/ this or if they do, choose not to make it a part of their focus (as they lack the background, it's not relevant to the problem etc.)...

why are psychiatrists covered by insurance plans, and not psychologists? just b/c they can prescribe medication? psychologists have to be trained as well and have a PhD so I don't understand why this distinction is even made though in terms of who it is "okay" to see and who it's not....

 

[David Baxter PhD]

no clinical textbook has ever written about or included a chapter on physiology

Perhaps this is true for textbooks written for academic courses on "Clinical Psychology" or "Applied Psychology". I don't think it's true for books written for practitioners.

For example, I have a book (written in a kind of boring style but nonetheless relevant) called "Biologically Informed Treatment of Depression".

why are psychiatrists covered by insurance plans, and not psychologists?

That's largely (1) historical, since psychiatrists are MDs and therefore underthe medical umbrella, and (2) political, since physicians tend to have more powerful lobbyist influences than other mental health professionals.

 

[Eunoia]

yes, sorry I wasn't very specific- he was talking about Clinical textbooks for university level classes...

then, is there ever any way to use that $ that the insurance is willing to pay to see someone else for therapy? or would you only be able to do this if one's insurance or employment ins. covers some kind of fee for therapy by any mental health practitioner?

 

[David Baxter PhD]

Generally speaking, yes. Unless you see a non-physician therapist in a hospital program, national health insurance will not fund it.

 

[Retired]

Can you ever really tell a psychiatrist that you don't want to take meds if they would prefer you do?

No one is compelled to take any prescription or undergo any therapy against their will. Some people do refuse the recommendations of their physicians for various reasons.

However, the reasons for refusal should be examined. If one has doubts about the competence of their physician or other health consultant, then either a second opinion should be sought or change physician.

Another consideration is if one is expecting their insurance company to continue coverage for a benefit such as long term disability, the claim might be turned down if the patient refuses therapy.

The concept of becoming a partner in one's health care applies even more a situation where one might disagree with the direction of one's care.

Reliable information and research are one's best tools to be able to intelligently discuss options with one's care giver.

Bottom line is that each of us is in charge of our own health care, and we consult with specialists to advise us. These specialists can be physicians, psychologists and other competent health care professionals. We can educate ourselves using resources like this Forum and other reliable medical information sites in order to be able to have a dialog with our consultants about the form our therapy might take.

What about when one's judgment is impaired through a psychiatric disorder?
[/quote]

 

[Eunoia]

What about when one's judgment is impaired through a psychiatric disorder?

good point. at what point do you call the patient no longer able to make his/her own decisions in regards to this... aren't all people somewhat "clouded" in their decision making if they have a psychiatric disorder? By no means do I think it is right to force just anyone to take medication (!!) but for ex., if you know it might have benefits but you still choose not to take meds, then where do you go from there? there is nowhere to go from here.

 

[Retired]

I believe some jurisdictions have provisions for a so called living will, or mandate where the person makes their wishes known in writing. The document is usually notarized or otherwise made official, then a trusted family member is designated to make medical decisions on behalf of the incapacitated person.

But what if such a document is not available? What happens in your jurisdiction?

Does one have to go to a lawyer or notary to prepare such a document ans what should a document like this contain?

 

[Eunoia]

I'm pretty sure that this is the kind of document they would use here too... but that it would have to be acknowledge legally before hand. what I was getting at though, and this may not have been your original question, it seems somewhat "clear" what to do in extreme cases, but what about other disorders? any disorder I can think of has some kind of cognitive distortion or faulty thinking (then again the general population also has faulty beliefs in some regards)... but say, if a patient has disorder "x" and you know medication "Y" might help, but they don't want to try... how do you start working on the problems if the client can never get to that point of being able to be in therapy, be motivated enough, have enough energy etc... (which meds might help with).... then what?