What to tell my psychiatrist?


5 Ways to Maximize Results with Your Psychiatrist

By bp Magazine

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    Seeking help for bipolar can sometimes feel unsettling. You can set your mind at ease—and improve your care—by following these 5 tips for an effective appointment with your psychiatrist!

    #1 Define the problem beforehand

    Prior to your appointment, take some time to think about what it is you want to get out of the appointment. Bipolar disorder symptoms and issues can change between each meeting, so defining exactly what you want help with will save time, allowing you to spend more valuable resources on getting the precise help you’re after.

    #2 Respect the time

    Try to keep the chatting with your psychiatrist to a minimum and instead talk about the important things pertaining to your issues. Along these lines, if there are several issues, bring up the most important topics at the start of the appointment, instead of near the end of the meeting, when there isn’t enough time to discuss the higher-priority concern.

    #3 Be detailed in your history

    In order for the doctor to help you, you need to provide enough appropriate information. This could mean a detailed history, records from prior treatments, a list of current medications and dosages (which includes non-psychiatric and over-the-counter medicines, as well as alternative supplements). If you keep a daily health journal, bring that, too. Knowing the amount of sleep, what you’re eating, the amount of exercise and so on can be extremely beneficial.

    #4 Don’t expect miracles

    Try to keep your expectations fair. Since everyone is different, their situation is different, and experiences with bipolar disorder vary, so you can’t assume your psychiatrist will magically understand your problem. Work with him or her by giving a comprehensive view of what you’re going through, and keep some patience. Also, if you’re asking for advice, then either follow that advice or explain your reasons why you choose not to. Communication is key.

    #5 Be honest about medication compliance

    You are only harming yourself if you choose to not tell the truth about whether you’re taking your medication regularly and at the proper dosage. If you don’t agree with the prescription ordered for you or you are having a problem with it, it’s vital you address this issue with your psychiatrist. If you’re not honest about medication compliance, your doctor could prescribe more medication or higher dosages than what is required.

    Source: “New Models of Psychiatrist- Patient Relationships,” kevinturnquist.org

    • “I’ll defer to your judgment on this one,” I said to my psychiatrist, shrugging.

      “You defer to me a lot,” he pointed out, laughing. “You’re allowed to have an opinion.”

      I was?

      As a mentally ill person, I was so accustomed to having decisions made for me that I was baffled when my new psychiatrist was giving me the final say on my treatment – not just once but consistently.

      That’s when I realized: No one ever told me what a good psychiatrist looked like, let alone the kind of treatment I deserve.

      And this is nothing short of tragic because the relationship that we have with our psychiatrist can make or break us. When our mental health impacts every aspect of our lives, having a positive and trusting relationship can be the difference between surviving and thriving.

      It took seven years of navigating psychiatry to finally find a clinician that I felt safe with. Seven. Years.

      This is due, in large part, to the fact that I simply accepted whatever treatment I was given, rather than advocating for myself.

      I didn’t know how to recognize when a clinical relationship was working for me, and when it wasn’t – and I was convinced that it didn’t matter as long as I could fill my prescriptions at the end of the day.

      But it does matter. And as both a mental health advocate and a patient, I know now that a caring and competent psychiatrist can make a huge difference.

      My current psychiatrist is the-bomb-dot-com. And I’ve been reflecting lately on why that’s the case: What exactly does he do differently? And what should we, as mentally ill folks, start to expect from our clinicians?

      There are positive signs that I think we should all look out for in our clinical relationships – not just to help us find a good fit, but to give us the language to advocate for ourselves with every psychiatrist that we meet.

      Here are seven signs to get you started.

      1. They Look at You

      When my psychiatrist came out from behind his desk, pulled up a chair across from me, and grabbed his laptop instead of hiding behind his desktop computer, my first thought was, “What the hell is he doing?”

      He had a desk and a computer – why did he need to relocate right across from me?

      But there was something about his relaxed posture, his complete attention, and most importantly, his consistent eye contact that totally disarmed me.

      I immediately felt more trusting of him – something I hadn’t experienced with previous psychiatrists.

      My last psychiatrist back in Michigan seldom looked at me, only to greet me and say goodbye. She stared at her computer, rapidly typing as I spoke, saying very little to acknowledge what I had said.

      In hindsight, I realize this is why I always found our interactions to be cold and why I always held back on the details when speaking to her.

      Something as simple as direct eye contact can change the entire temperature of a room. I went from feeling invisible to being seen.

      I can’t emphasize enough what a difference this has made.

      2. You Don’t Feel Rushed

      In my work as an advocate, the most common complaint I come across is that folks feel their appointments are always cut short, or that they never have enough time to say what they need to.

      The pace of the conversation and allotted time ultimately makes them feel like a burden, and they ask fewer questions, share less information, experience significant anxiety, and ultimately receive subpar treatment because they feel rushed.

      I realize this varies widely depending on the clinic and clinicians you have access to, but I encourage folks to explore their options as much as possible.

      It’s critical that you don’t feel like you’re always running out of time – this can absolutely impact your interactions and treatment.

      I’m always blown away by how long my psychiatry appointments are now, and the fact that my psychiatrist always asks at the end if there’s anything else I’d like to talk about, no matter how long the appointment has already been.

      We decide together when everything has been said – I’m never pushed out the door.

      And if I open a (non-urgent) can of worms right at the end of an appointment, we make another appointment to discuss it, so I’m assured that it will be addressed and I know exactly when it will be.

      Check in with yourself during your appointments. Do you feel rushed? Do you feel like you’re always running out of time? If you do, don’t be afraid to mention this.

      3. They Respect Your Agency and Give You Choices

      When I was struggling with binge drinking, my psychiatrist didn’t tell me what I should and shouldn’t do.

      He made a few recommendations about resources that I could choose from, but then went on to tell me he trusted that I knew what I needed.

      He believed in my self-determination, and affirmed that I was in charge. He didn’t criticize me for relapsing, or tell me that he knew what was best for me. He gave me choices.

      Not once has my psychiatrist made a recommendation for me without giving me other options, and asking me how I felt about the options I was given.

      My psychiatrist told me that he strongly believes in collaboration and self-education. In other words, he believes in my agency. I can’t emphasize enough how critical this is for mentally ill folks who – far too often – aren’t trusted to make competent decisions and are talked at rather than talked with.

      This approach is both humanizing and, yes, anti-oppressive, as it upholds the belief that mentally ill people are truly the experts on their own lived experience. And we are.

      So ask your psychiatrist what the word collaboration means to them in a clinical setting. This is far and away one of the most important signs about what kind of relationship you can expect, and what your treatment might look like.

      4. Your Input Is Valued, Not Discouraged

      My psychiatrist is always asking me for my opinions and for feedback, encouraging me to be an active participant in my treatment.

      And I’m baffled that this isn’t the status quo.

      As an advocate, I hear time and time again, “My psychiatrist was annoyed by how many questions I was asking” or “My psychiatrist was bothered by how much I was pushing back.”

      Just recently, someone told me that their psychiatrist actually said to them, “You don’t get to call the shots. I do.”

      This is a big, ol’ red flag, and you should head for the hills if a psychiatrist ever discourages you from being invested in your own treatment and wellbeing.

      A good psychiatrist wants you to stay engaged. A lousy psychiatrist wants you to be seen, not heard, and to swallow your pills dutifully.

      Don’t be afraid to seek out a different doctor if you feel that your psychiatrist isn’t listening. Newsflash: A big part of their job is listening – and if they aren’t, they’re failing you as a clinician.

      5. There’s Mutual Trust Between You

      During my last bout of depression, I sent an online message to my psychiatrist describing how suicidal I was and what plans I had.

      I was truly at the end of my rope, and I didn’t know what else to do.

      My psychiatrist didn’t call 911, though. He called me.

      He calmly checked in with me, convinced me to go to the emergency room, and when I said I was on my way and that my partner was with me, he believed me. He then called the ER, filled them in on my situation, and told them to expect me.

      This completely shocked me. But because I had trusted him and shared my suicidal thoughts, he trusted me to do the right thing. And you know what? I did.

      I admitted myself voluntarily – which anyone will tell you is preferable to being involuntarily committed and traumatized.

      That kind of trust has been critical in my treatment. I feel respected and believed – and in return, I feel that I can open up and be honest about what I’m struggling with.

      If you can’t trust your psychiatrist and the treatment they are recommending, how can you sustain the hope that things can and will get better? And how can you confide in them if you’re closing yourself off?

      Trust is foundational in any clinical relationship. Do you trust your psychiatrist? If the answer isn’t “yes” or “we’re working on it,” then it may be time to find someone else.

      6. They Acknowledge Your Identity and Trauma History

      I’m transgender. And I’ve had so many psychiatrists who have pretended this isn’t the case.

      Many psychiatrists have ignored the fact that my hormones do impact my mood. And almost every clinician has misgendered me, referred to me as “female,” or asked me questions that were completely inappropriate.

      This is shit that I don’t put up with.

      Weirdly, my current psychiatrist is the most trans competent psychiatrist I’ve ever had, despite never advertising himself as such.

      I also have a significant trauma history, something that I’ve noticed many psychiatrists feel that therapists are exclusively responsible for knowing about in any detail.

      But my psychiatrist has been very open to hearing about that history, and taking it into account when diagnosing and making treatment recommendations.

      Which is all just to say, if your psychiatrist isn’t interested in the big picture – the aspects of your identity and history that have contributed to your mental health – they may not be a good fit.

      If these things are important to you, they should be important to your psychiatrist as well, at least to some extent.

      7. They Are Open to Alternative Diagnoses

      When I was eighteen, I met with a psychiatrist who accused me of looking for an “easy way out,” being too young for medication, being too dramatic, and who – after all this – shrugged and said to me, “Which pills did you want?”

      (I picked Prozac because I saw it on TV. She prescribed it without question or concern.)

      She diagnosed me as bipolar after about ten minutes of yelling at me. And that label has followed me around since then, not being challenged or questioned by any of my clinicians until my most recent psychiatrist revisited it.

      And guess what. I may not be bipolar after all. Borderline, ADHD, complex PTSD, OCD – these are labels that I only considered after my most recent psychiatrist had a real conversation with me, and these are labels we continue to revisit and explore.

      Diagnoses are markers that can determine the entire course of treatment. Which therapies and medications are recommended can rely on these labels, and how we come to understand our struggles can be framed around these labels as well.

      For the last seven years, it’s possible that I was receiving treatment for a disorder I might not even have. This is a huge deal.

      This is why it is so incredibly important that we have psychiatrists that don’t take these diagnoses for granted. If something doesn’t feel quite right, don’t be afraid to ask for a reassessment.

      If there’s a label that might fit better, don’t be afraid to introduce it to the conversation (because yes, there’s a place for self-diagnosis in psychiatry).

      A good psychiatrist is open to new possibilities, and those possibilities can ultimately impact your mental health in big ways.

      I don’t know at what point I started accepting whatever treatment I got. But I can tell you that now that I’ve had positive psychiatric experiences, I’m unwilling to go back to the days where I was a passive and jaded patient.

      I can see the difference a good psychiatrist can make.

      The sense of agency, trust, and validation I feel is absolutely priceless – and with each new success, I’m grateful for the amazing clinicians out there who make it a point to respect and uplift us, not perpetuating the harm and abuse that psychiatry can so often enact on mentally ill people.

      I expect and demand much more now. And I believe we all should.

      This piece that I wrote originally appeared at Everyday Feminism.

      20 Secrets Your Therapist Isn’t Telling You

      Deciding to get help for mental health issues is no easy feat. Finding the right therapist and exposing your most intimate thoughts often means overcoming multiple mental hurdles standing in your way. In fact, research suggests that just 49 percent of people with major depression aren’t getting treatment for it, and the fear of facing a therapist might just be the reason why.

      However, while seeing a therapist can feel scary, learning the ins and outs of this unique profession may help you feel more comfortable before you book that appointment. We’ve compiled 20 things your therapist won’t tell you, demystifying those sessions in the process. And when you want to work on yourself outside therapy, start with the 25 Ways to Be Happier Now!

      1 They Can Only Help You If You Want Help

      The first step toward any therapeutic goal is wanting to achieve it. In fact, the only way your therapist can really help you is if you’re willing to involve yourself in the process. “There are people who are content, even happy, in their dysfunctional ways or relationships. I could talk till my face turned blue (or my client could talk till their face turned blue) but if they are shutout, things won’t get very far. It’s as sad as it is frustrating,” says one therapist. And for more trade secrets, don’t miss the 20 Things Your Divorce Lawyer Won’t Tell You.

      2 Drinking Is One of the Biggest Issues They See

      Before you head to a psychiatrist to ask for antidepressants, try limiting the number of depressant substances you’re taking in. For many people, this means steering clear of booze.

      “Excessive alcohol consumption, at a level not usually considered problematic, impacts people a lot more than they think it does,” says one therapist. “Think about cutting down your drink before turning to anti-depressants.” Thinking you’re ready to put down the bottle? Try these 7 Genius Tricks for Navigating Your Dry January.

      3 Their Note-Taking Does Serve a Real Purpose

      It can feel very strange to have a therapist take notes on everything you say during a session, but don’t worry: they serve a very important purpose. And no, they’re not writing the ways they judge you.

      “I read my when the room,” reveals one therapist. “It’s just notes of everything I said, and potential thought paths that can be followed, as well as potential conclusions.”

      4 Your Therapist is Probably in Therapy

      While saying “all therapists are crazy” is a bit reductive, it’s probably true that the person treating you is in treatment themselves. “I actually get really annoyed when I hear of therapists who’ve never been in therapy,” says one therapist. “In fact, I am currently in therapy, and I think it’s good practice for therapists to be in therapy.” And for more on the benefits of therapy, know that it’s one of the 40 Secrets of Couples Who’ve Been Together for 40 Years.

      5 Their Careers Can Be Isolating

      While setting your own schedule and charging $250 an hour may seem like a dream, a therapist’s career has plenty of downfalls, including isolation. “Professional isolation is real, especially when you’re solo like I am,” admits one therapist. “I have a few outlets where I’m able to connect with others, but unless I’m very intentional about doing so, I can quickly start to feel disconnected from my peers.” And if you’re feeling isolated or depressed, consider these 70 Genius Tricks to Get Instantly Happy.

      6 Violent Behavior is Par for the Course

      While most people imagine therapy being a gentle and soothing process, many therapists are exposed to violence in their line of work. “I have had clients physically attack me,” says one therapist. “Every time it freaks me out.”

      7 It’s Pretty Common for Parents Not to Love Their Kids

      Think you’re a monster for not feeling particularly bonded to members of your family, even your own children? You’re definitely not alone. “Not caring deeply for family members . Especially for their children,” says one therapist. “They expect this instinct to kick in at some point where they’ll feel fiercely protective, but it never happens.”

      8 Crying Doesn’t Faze Them in the Slightest

      If you feel odd about crying in front of your therapist, don’t. Crying is a natural and healthy part of the process. “I can’t speak for all of us, but the majority (I think) are pretty comfortable with crying,” says one therapist. “The ones who aren’t need to get there or find a new job. I’ve told many clients that if they are feeling uncomfortable (angry, upset, teary, etc) we are probably moving the right direction.”

      9 Seemingly Small Problems Can Cause Major Stress

      Just because an issue seems small to someone else doesn’t mean it can’t cause you serious trauma. Being hung up on seemingly minor issues is something therapists see every day, and it’s well worth exploring. “Someone’s distress about their problem doesn’t necessarily correlate with how big that problem objectively looks to others,” reveals one therapist. And if you’re looking for simple ways to get out of your mental rut, the 25 Best Instant Mood Boosters are a great place to start.

      10 Narcissists Are Some of Their Hardest Patients

      While violent patients may be the scariest, the ones with narcissistic personality disorder are generally the hardest to treat.

      “The worst one I’ve seen have almost constant complaints about everyone else in their lives and even society as a whole,” says one therapist of their narcissistic patients. “The saddest cases are the ones that are really failing at life. They’re so bitter and they often can’t get any further than complaining about everybody else.”

      11 They Do Get Frustrated With Their Patients

      Just because your therapist is keeping their cool in front of you doesn’t mean they’re not frustrated. A lack of progress or insight can be a major source of frustration, even for a seasoned pro. “I’m not much of a yeller in general, but yes, I’m human and do get frustrated. There are definitely times I want to say, ‘Just try ____!!!! I know it will work, gah!!'” says one therapist.

      12 They Often Don’t Get to See the Outcome of Their Work

      While it’s nice to imagine that every therapeutic relationship comes to a satisfying conclusion, that’s rarely the case. “Not all of my clients keep in touch after we work together, so often don’t get an idea of how many I have helped in a lasting way,” reveals one mental health professional. “It’s one of the hard things about being a therapist.”

      13 Bad Parenting Causes Some of the Worst Mental Health Outcomes

      Bad parents do more than ruin birthdays—they ruin lives. “Having bad parents will mess you up for life,” says one psychologist. “Even if you find a way to have career success, a happy relationship, and meet other goals, internally something will be off for you.”

      14 Intrusive Thoughts Happen to Everyone

      If you’ve ever found yourself thinking what your landlord looks like naked or wondering what it would be like to jump in front of a moving train, you’re not alone. Intrusive thoughts happen to many people, even those who aren’t suffering from mental illness.

      “Sudden, unwelcome, sometimes even violent, thoughts that pop into your head are also normal and not indicative of psychopathology or sexual perversion. They’re intrusive thoughts and as long as you don’t think you’re going to act on them, there’s no reason to worry about them,” assures one therapist.

      15 Most People Repeat the Same Destructive Patterns

      Even if it feels like the issue you’re going to therapy for is a new one, odds are it’s actually something that’s come up before. “Very little about you is original as we’re constantly repeating patterns we’ve learned since childhood,” says one therapist. “When humans find a solution, no matter how maladaptive it turns out to be in the long run, we stubbornly keep trying it over and over and over.” Luckily, you can start making healthier choices today by performing The Single Best Exercise for Your Brain!

      16 Fear of Judgment is More Universal Than Patients Think

      Think you’ll sound paranoid if you reveal your concerns about being judged by others? Don’t worry: this fear is practically universal. The most common fears, according to one therapist? “That everyone is looking at them and their decisions and judging them that their family can’t relate.”

      17 They Know When Patients Aren’t Sober

      Heading to therapy when you’ve had a few is not only obvious to your therapist, it may be grounds for them to end your relationship. In fact, one therapist says that being under the influence of drugs or alcohol is the worst thing a patient can do during a session.

      18 Sleeping With Patients Will End a Therapist’s Career

      Many patients may fantasize about having a tryst with their therapist, but don’t count on it happening. Not only is it wildly unprofessional, most therapists agree that fellow clinicians who cross the line with patients should lose their licenses.

      “Some therapists find a client’s vulnerability sexy or enticing. While I never have, a woman who graduated with me had her license yanked for engaging in inappropriate relations with a male client,” reveals one therapist. “Honestly, it isn’t worth losing your career over.”

      19 Confidentiality is Everything to Them

      Don’t be worried about your therapist blabbing about your issues to their friends and family. In fact, confidentiality is one of the most important parts of their profession.

      “I only need to break confidentiality if the person is a danger to themselves or other people,” says one therapist. “Thankfully, it’s pretty rare for the most part.”

      20 Just Because They’re a Therapist Doesn’t Mean They’re Your Therapist

      Finding the right therapist for you can be an amazing experience. However, that doesn’t mean that every therapist you meet is auditioning for the role.

      “As soon as you mention the word psychology people see it as a gateway to tell you all of their problems. A simple lighthearted conversation with a stranger can turn into me knowing their full family history and the reasons why they drink so much,” says one psychologist. Luckily, you can still improve your mental health outside of therapy— just Steal These 16 Mental Health Secrets of Famous Geniuses!

      To discover more amazing secrets about living your best life, to sign up for our FREE daily newsletter!

      Are You Telling Your Doctor the Truth About Your Depression?

      Depression Symptoms: What Your Psychiatrist Needs to Know

      The first thing anyone with depression should know is that depression symptoms require medical treatment. Depression is a disease. But feelings of sadness, guilt, hopelessness, and helplessness can be hard to admit to. “You may be more likely to omit symptoms than to flat-out lie about symptoms,” says Dr. Cora. “Part of a therapist’s job is to help you open up by asking the right questions in the right way.”

      When you’re talking about your depression, make sure to let your therapist know about:

      • Medications you take. Medication for depression can sometimes require adjustments. Let your psychiatrist know about any side effects you’re experiencing, and never stop a medication without talking to your doctor first.
      • Sources of stress. “Let your therapist know about any problems at work or at home that cause you stress,” says Cora. “Problems like being out of work or going through a divorce may be hard to talk about, but your therapist needs to know what’s happening in your life in order to help you.”
      • Drug and alcohol use. Self-medicating to deal with your depression symptoms is always a mistake, but it becomes even more dangerous when you keep these behaviors to yourself.
      • Physical symptoms. Depression doesn’t just affect your mood. “Physical symptoms like trouble sleeping, loss of appetite, loss of energy, or loss of interest in sex are always important to talk about,” Cora says. “Sexual problems can be especially hard for men to admit to, but sharing these symptoms with your doctor is important for depression management.”
      • Thoughts of suicide. Never, ever keep these thoughts to yourself. More than two-thirds of all suicides are caused by depression. Serious suicidal thoughts are a medical emergency and you should always tell your therapist. If you can’t reach him or her, the U.S. National Suicide Prevention Lifeline is available in emergencies at (800) 273-8355.

      Depression Management Is a Two-Way Street

      If you are still having trouble talking about your depression after seeing your therapist for some time, it may be that you’re not connecting with that person. Like all relationships, often it takes more than one try to find the right person for you. “Your therapist needs to give you enough time to talk,” says Cora. “The most important information usually comes out at the end of a therapy session. If after a few sessions you feel like you are talking to a stranger or you feel you are being judged, you need to find a new therapist.”

      Collins acknowledges the difficulties. “It’s no picnic having to bare what you perceive as ugliness to another, but if you don’t, you can never take ownership of your depression — it will continue to have control over you, and you will not progress. I believe you should tell your therapist everything and anything that is in your heart and mind,” she says.

      Depression is nothing to be ashamed of. A psychiatrist qualified in treating depression can help you to start building a foundation that will get you well if you truly open up to this important part of depression management.

      Reclaiming your power during medication appointments with your psychiatrist

      Meeting with a psychiatrist during “medication appointments” is usually a very disempowering experience. The meetings usually last for 15 or 20 minutes. During the meeting we are expected to answer a few perfunctory questions and to leave with prescriptions for powerful drugs that can dramatically alter the quality of our lives. In these meetings the psychiatrist assumes a position of power and we usually fulfill the expected role of being a quiet, unquestioning, passive patient. Subsequently we will be praised for merely being compliant or scolded/punished if we fail to comply with prescribed medications. Over the years I have developed a number of strategies for changing the power imbalance during medication meetings with psychiatrists. I would like to share some of these strategies with you.

      Strategy #1: Learn to think differently about medication

      1. There are no magic bullets. Recovery is hard work. No pill can do the work of recovery for me. If I sit back and wait for a pill to make me better, I will not get better. If I patiently wait for a drug to cure me I may become a chronic, helpless patient who swallows pills on command, but I will not recover. Recovery means taking an active stance towards the problems and challenges I face.
      2. Medications are only a tool. Psychiatric medications are one tool among many other tools that I can use to recover. Physical exercise, eating well, avoiding alcohol and street drugs, love, solitude, art, nature, prayer, work, and a myriad of coping strategies are equally important to my recovery.
      3. Using medications is not a moral issue. There was a time when I thought using medications was a sign of weakness or that people who no longer used medications were better than I was. I no longer think this way. There is no right or wrong way to recover. What matters to me is taking care of myself in such a way that I have a chance to become the best person I can be. There are periods of time when I do not use medications and there are times when I do. It is a personal choice that I make.
      4. Learn to use medications. Today I do not simply take medications. Taking medications implies a passive stance. Rather I have learned to use medications as part of my recovery process. Learning to use medications within the recovery process means thoughtfully planning and following through with medication trials, medication reductions and/or medication withdrawal.
      5. Always use medications and coping strategies. There are many non-drug coping strategies that can help alleviate symptoms and distress. Take the time to learn strategies for coping with voices, delusions, paranoia, depression, obsessive thinking, self injury, flashbacks, and so forth. I have found that learning to use a variety of non-drug coping strategies helps to minimize the amount of medications I take or, with practice, can actually eliminate the need for medications.
      6. Learn about medications. It is easy to feel intimidated by all the big words and technical jargon that get used about psychiatric medications. However, there are a number of ways that I have found helpful in getting reliable and accessible information about the medications I am considering using. I am careful to ask the psychiatrist I am working with about the medication he/she is prescribing. However, I often find this information insufficient. A great source of information is talking with other people who have used the drug. Perhaps the cheapest and easiest way to get more information is to ask a pharmacist who will give you a written fact sheet describing what the drug is supposed to do, what the unwanted effects are, and precautions including drug interaction information. These drug fact sheets are written in nontechnical jargon, but unfortunately leave out a lot of detail that might be important to you. If this is the case you can always ask your pharmacist for drug-insert information. The drug-insert information is essentially the same information that is contained in the Physicians Desk Reference (PDR). It is printed on a small roll of paper and inserted in the box of medications that the pharmacist receives. There is a lot of technical jargon in the insert but the information is more thorough than the fact sheet. In addition you can go to the library and use the Taber’s Cyclopedic Medical Dictionary to look up words you are not familiar with. There are also a number of good books that can help you get answers to your questions. These include Clinical Psychopharmacology Made Ridiculously Simple (John Preston and James Johnson, published by MedMaster, Inc.) or Instant Psychopharmacolgy (Ronald Diamond, published by W.W. Norton) or Toxic Psychiatry (Peter Breggin, published by St. Martin’s Press) or Natural Healing for Schizophrenia ( Eva Edelman, published by Borage Books, Eugene Oregon) or Living Without Depression & Manic Depression (Mary Ellen Copeland, published by New Harbinger). If you have access to the Internet there are lots of resources including these:
        • Dr. Bob’s Psychopharmacology Tips at http://uhs.bsd.uchicago.edu/~bhsiung/tips/tips.htmll
        • Healthtouch, with an excellent data base of over 7,000 prescription and over the counter drugs at http://www.healthtouch.com/level1/p_dri.html
        • Medline at http://www/ncbi.nlm.nih.gov/pubmed.

      Strategy #2: Learn to think differently about yourself

      1. Trust yourself. You know more about yourself than your psychiatrist will ever know. Begin to trust yourself and your perceptions. Sometimes I found it hard to trust my perceptions after being told that what I felt, thought, or perceived, was crazy. Part of recovery is learning to trust yourself again. Even during my craziest times there was a kernel of truth in all of my experience. If you are experiencing unwanted drug effects such as a feeling of apathy, constipation, loss of sex drive, double vision, or the like, trust your perception. Don’t let others tell you that such side effects are “all in your head.” Check with the pharmacist, or with friends who have used the drugs, and check the books or the Internet. Chances are that you are not the first person to have these drug effects.
      2. It’s your recovery. Too often I have heard people say that “the drug made me feel better.” Don’t give all the credit to the chemical! Even if you found a drug helpful, look at all the things you have done to get well and stay well. A drug can sometimes open a door, but it takes a courageous human being to step through that door and build a new life.
      3. Your questions are important. Anyone who has been on psychiatric drugs for a period of time is probably going to ask these important questions:
      • What am I really like when I am off these medications?
      • What is the “real me” like now?
      • Is it worth taking these medications?
      • Are there non-drug methods I can learn to reduce my symptoms instead of using medications?
      • Have my needs for medications changed over time?
      • Do I have tardive dyskinesia that is being masked by the neuroleptics I am taking?
      • There are no long-term studies on the medication I use. Am I at risk? Do I want to take the risk of not knowing the long-term effects?
      • Am I addicted to these medications?
      • Has long-term use of these medications resulted in memory loss or decreased my cognitive functioning?

      There is nothing crazy about having such questions. What is unfortunate is that most mental health professionals do not recognize that these questions are to be expected. A recovery oriented system would have detox centers and other supports available so that people could plan a rational withdrawal from medications in order to explore these important questions.

      Strategy #3: Think differently about psychiatrists

      1. Most psychiatrists are too busy for our own good. We would be wrong to assume that most psychiatrists have a thorough knowledge of their clients’ treatment history. In an age of managed care psychiatrists have less and less time to spend with more and more clients. Many psychiatrists have never read the full case record of the people they prescribe medications to. Even fewer could identify all of the various drugs and drug combinations that you have tried over the years and what the outcomes of those drug trials were. In light of this I have found it important to begin to keep my own record of what medications I have tried, for what symptoms, at what dosages, and for what period of time. Whenever a psychiatrist suggests a new drug or a new dose, I always check my record just to be sure it hasn’t been tried before. I don’t want to repeat ineffectual or even harmful drug trials.
      2. Psychiatrists often have conflicting interests. It would be comforting to think that psychiatrists were serving our individual interests. But this assumption would be naive. Many psychiatrist complain of the competing interests that tear at the ethical fabric of their practice. Especially if I am working with a psychiatrist who is part of a managed care system, I feel it is important to ask what, if any, caps on services he/she is working under. In other words, some psychiatrists receive their paychecks from managed care corporations that require them to prescribe one type of drug rather than others that are expensive. If this is the case, we should have this information!
      3. Sometimes psychiatrists are wrong. Most psychiatrists do not encourage us to seek second opinions regarding diagnosis, medications, or other somatic treatments such as ECT. However, at certain times I have found it important to seek out a second opinion. Even with a managed care plan or if you are on Medicaid or Medicare, it is possible to get a second opinion on an issue you deem important. It can take a lot of work, phone calls and even a friend to help advocate, but it can be done and you are worth it!
      4. Psychiatrists are not experts on everything. Most psychiatrists believe in the primacy of biology. Most have a mechanized and materialist world-view. Thus, chances are that if you have a diagnosis of major mental illness and you talk to your psychiatrist about ecstatic spiritual experiences, mystical experiences, psychic abilities, or similar experiences, these will be perceived as crazy or symptomatic. One way of taking back your power is to recognizethat you have control over what you share with a psychiatrist and what you choose to keep private.

      A meeting with a psychiatrist need not be a confession! Talk with mystics about your mystical experiences. Talk with psychics about telepathy, etc.

      Strategy #4: Prepare to meet with your psychiatrist

      1. Set your agenda for the meeting. I have found it important to set my agenda for a meeting with a psychiatrist rather than simply reacting to what he/she does or does not do. In order to set an agenda it is important to define your immediate goals. Possible goals might include starting medication, discussing a medication change, planning for a medication reduction, planning for a medication withdrawal, checking for tardive dyskinesia, finding a solution for unwanted drug effects, or reporting on a medication trial. Try, if possible, to set one goal for each meeting.
      2. Organize your thoughts and concerns. I have also found it important to prepare ahead of time for a meeting with a psychiatrist. I have developed a form that helps me organize my thoughts and to put things in writing. A copy of this meeting preparation guide is available through the National Empowerment Center.
      3. Be specific. The more specific we can be about our concerns, the more control we can exercise during a meeting with a psychiatrist. For example, if a psychiatrist begins a meeting by asking, “How is that new medication working?” a vague answer would be “Oh, it’s helping a little I think.” Imagine how empowered you would feel if, instead, you were able to answer, “Well, before I began this medication trial I was so depressed that I missed seven days of work, spent 14 days in bed and lost 3 pounds. But during the last two months, since starting the drug and using the new coping strategies, I have only missed 2 days of work, have regained the weight I lost and I have only spent 4 days cooped up in my apartment.” Notice how this level of specificity puts you squarely in the driver’s seat of your life and positions the psychiatrist as a co-investigator, as opposed to being the authority over your life. Getting this specific may sound difficult, but it is not. It simply requires that you learn how to record your medication and/or self help trial on a daily basis and that you summarize this information before seeing your psychiatrist. A guide to recording your medication and/or self-help trial is available through the National Empowerment Center.
      4. Write your questions down. Write your questions down before seeing your psychiatrist. Bring the questions with you to the meeting. My experience is that these meetings can be stressful and that having my questions written down allows me to relax a bit. If you are considering trying a new medication, be sure to ask the following questions:
      • Exactly how will I know if this medication is working for me?
      • How long before I should start to notice an effect from this medication?
      • What are the unwanted effects or side effects associated with this drug?
      • If I should experience unwanted side effects, what should I do about it?
      • How can I contact you if, during this medication trial, I have questions of concerns I want to check out with you?
      1. Role-Play. Sometimes it can be helpful to role-play with a friend or someone you trust before seeing your psychiatrist. Learning to talk to a psychiatrist from a position of personal power is a skill that can be learned and must be practiced. Be patient and give yourself time!

      Strategy #5: Take charge of the meeting

      1. Bring a note pad and pen to the meeting. Most of us have had the unnerving experience of talking to a psychiatrist while he/she busily jots notes that we never get to see. Bringing your own note pad and pen, and taking your own notes is a good way to break the habit of being a passive patient. It gives you something to concrete and active to do while in the meeting. Writing notes can also help you remember important points.
      2. Tape-record the meeting. I can get very anxious when meeting with a psychiatrist and thus a lot of information passes by me. I have tape recorded meetings so that I can listen to them afterwards and pick up on the information I may have missed. I have always asked permission before recording. Although some psychiatrists don’t feel totally comfortable with the idea (they fear lawsuits), all have agreed to it when I explain why I am taping the meeting.
      3. Announce your agenda at the beginning of the meeting. If you have done your meeting preparation work, then you know what you want to get out of the meeting with your psychiatrist. There have been many times when I bring two copies of a one-page, written statement of my agenda, concerns, and observations to the meeting. I hand a copy to the psychiatrist and begin the meeting by reading my statement out loud. My experience has been that most psychiatrists initially object to my starting this way. They are accustomed to starting meetings with their own agenda, which is usually vague and centered on the notion that they will observe me for significant clinical signs and symptoms while I answer the questions. But if I insist on beginning the meeting with my statement and assure them they can talk later, I find they soon come to understand the value of my preparation. In fact, some of the psychiatrists I work with keep the copy of my agenda and statement and add it to the clinical record. For a sample copy of an opening statement, contact the National Empowerment Center.
      4. Bring a friend or advocate. Many people bring a friend or support person when they see a dentist or have a physical exam. It makes sense to bring a friend to a meeting with a psychiatrist, especially when you are first breaking out of the role of passive patient and are learning to reclaim your power.

      These strategies have worked for me. Together these strategies have helped shift the balance of power between me and the psychiatrist I am working with. Perhaps some of these strategies will make sense to you. I am sure that you will come up with your own strategies as well. What is important is to realize that you can take your power back and become the director of your own recovery and healing.

      What to Expect at a Psychiatry Appointment

      May is Mental Health Awareness Month. Psychiatry is a vital part of mental health treatment. In the United States, one in six people takes psychiatric medications. These medicines help people to live balanced, healthier lives.

      Even with the prevalence of treatment options and prominence of medications, a stigma exists. These factors can make seeking treatment a daunting task.

      Psychiatry today

      There are approximately 28,000 psychiatrists in the United States. These doctors play an important role in health care, especially in the wake of the opioid crisis. Recruitment for psychiatrists is second only to family physicians.

      In a previous post, we discussed the differences between psychiatry and psychology. Now, we’ll take a closer look at what it’s like to visit a psychiatrist.

      Psychiatrists are medical doctors. These physicians can also practice psychotherapy. But the primary job of a psychiatrist is medication management. Larger practices may consist of a team of people.

      These teams include various medical professionals capable of making diagnoses and prescribing medications. These include psychiatric nurse practitioners (NP) and physicians assistants (PA).

      There may also be psychologists, licensed professional counselors and social workers. These team members may also be doctors, but they hold Ph.D.s and cannot prescribe medication.

      Psychiatry appointment

      Seeing a psychiatrist for the first time can be intimidating, but there is no need to worry. The following list tells you what to expect at a psychiatric appointment.

      1. The first visit is the longest.

        Your intake appointment can take one to two hours. You’ll fill out paperwork and assessments to help determine a diagnosis. After that, you’ll have a conversation with the psychiatrist and an NP or PA may observe. The doctor will get to know you and come to understand why you are seeking treatment. There will be a lot of questions for you to answer.

      2. Phone a friend.

        Many doctors understand that on your first visit you may want to have a loved one or close friend with you. If you elect to bring someone with you, they should know you well and be able to share about you. You don’t have to bring anyone, but this confidant may be able to remember critical details you may forget.

      3. Write it down.

        Before your psychiatry appointment, write down why you are seeking help. Highlight critical behaviors which cause you concern. This exercise will help you stay on track and lessen the likelihood of you forgetting something. While you’re in your appointment, it’s also a good idea to write down what the doctor says so you can implement it when you leave the office.

      4. A simple physical.

        Many psychiatrists will take your vitals on your first visit to establish a baseline. They will take your blood pressure and temperature and many will also weigh you. There is also the possibility of a blood draw. In some cases, your doctor may send you for further testing or scans.

      5. Get to know your psychiatrist.

        You will be working with the doctor, NP or PA for a while on your health. It is a good idea to prepare questions so you can understand more about their method of treatment. You are expected to ask questions during your sessions.

      6. Treatment plan.

        By the end of your first or second session, the doctor will have a treatment plan for you to begin. He or she will provide you with prescriptions and advise you on how you will move forward. It is imperative to discuss all medications you are taking with your doctor. This step ensures sure your prescriptions don’t negatively interact.

      7. Shorter sessions.

        After the initial intake, future psychiatry appointments will be shorter; on average between 15 and 20 minutes. You’ll discuss how the medicines are working and give a concise overview of how you’re doing. The doctor, NP or PA will decide whether to adjust your medications or not.

      Psychiatry is worth it

      Dealing with a mental health diagnosis is as important as physical health. It may be new territory, but it is worth it to get you on a healthy path. It is often suggested to see a psychologist along with your psychiatrist. In the best case scenario, these doctors will work together on your treatment.

      To facilitate this, both doctors will offer you a release form. These forms give them your permission to communicate freely to create the best treatment plan for your health. A psychologist spends more time with you and knows more details about your current state. They can share this information with your psychiatrist.
      Both doctors will help you achieve your mental health goals. If you’re looking to start your psychiatry journey, the Holiner Group team is here to help. We have locations in Dallas and McKinney. We have a talented staff and want to assist you. Contact us, today.

      How to handle your first meeting with the psychiatrist

      Mentally Aware Nigeria InitiativeFollow Jun 21, 2018 · 4 min read

      So you have finally made it past that first hurdle of admitting to yourself that you need a professional for your mental health issues, and you want to see a psychiatrist or a shrink as some of us like to call them. However, you are not exactly sure how to go about it and you have a few questions? This article could help with some of those questions and tell you much of what you need to know about your first meeting with the psychiatrist.

      How do I go about this?

      Note that it will usually take up to an hour or more (mostly more). One of the most difficult things about having a mental illness is actually seeking help, and you might even be questioning if you need it or not. You should know the following:

      • It is a doctor’s office, and there’s nothing to be ashamed of
      • Make sure you go there with the intention of being committed to your treatment
      • Don’t expect all the answers immediately
      • If you get medications, they might not work immediately, so don’t be too hard on yourself.
      • Having a mental illness does not make you a flawed human being.
      • It’s totally fine to seek help

      After booking an appointment, you could take the following steps to help you handle your first meeting with your psychiatrist.

      Write down everything you might want to talk about before hand

      A lot of people find that it helps to write down the issues that they want to discuss beforehand. This could be very helpful at a first meeting because you might get nervous (this is only normal, it is not every day you decide to talk honestly to a total stranger about your problems) and putting things down before the meeting might help with any details you might forget in the heat of the moment.

      You might want to consider taking a loved along with you to this first meeting

      Now we all know it is not easy to let your family or loved ones in on your mental health problems, but an understanding loved one could provide a great support system for you during this first visit and maybe even consequently if need be. During the therapy session, they could help fill in some of the blanks you miss while talking about your issues, give a second person perspective and because they know you better and probably live with you, will be able to explain some of your behaviors and moods and other observations better to the psychiatrist. Two heads are always better than one, and just the thought that someone who loves and supports you is with you on this could make talking about things a whole lot easier.

      Be open and honest with your psychiatrist

      This might seem like the hardest part of this process, but in this case as with most other situations, Honesty really is the best policy. Your psychiatrist will simply not be able to help much if you are not completely honest about your problems. Open up about everything, even if they sound strange, embarrassing or simply unusual. Whether it is a repetitive and unnecessary need to check that doors are securely locked, Nymphomaniac tendencies, an obsessive need for everything to be perfect all the time, or self mutilation etc, Understand that it is not your psychiatrist’s job to judge whatever choices you may have made as a result of your mental health issues, but to help you through your mental health problems. Be rest assured nothing you say will leave the room, it is called doctor-patient confidentiality.

      Don’t be Afraid to ask Questions

      Don’t be reluctant to ask your psychiatrist questions about anything you are not clear about, no matter how unnecessary it may sound. Inquire about medication options available to you but know that not all mental health problems necessarily require medication to resolve them. Some only require therapy but if you are prescribed Anti-depressants or other medications by your psychiatrist, Ask questions about it, why you should be on this particular medication, how it helps, how long you ought to take it and ask questions about your mental health issue.

      What will happen during my first psychiatric appointment?

      During your first appoint your psychiatrist will probably:

      • Listen to your Issues, concerns and symptoms
      • Ask questions about your general health
      • Ask about your family history (Here questions about your family will come up: Does anyone else in your family have mental health problems, Do you or did you have family members with a history of mental illness? Etc. Remember to be honest and open!)
      • Take your blood pressure and do a basic physical checkup if required
      • Ask you to fill out a questionnaire (Source: Yourhealthinmind.org)

      What should I talk to my psychiatrist about?

      You can talk about everything and anything you feel needs talking about. Your psychiatrist is there to listen without any judgement. If you feel like your psychiatrist is judging you, or you’re getting negative vibes, or you’re uncomfortable with the person, kindly change the psychiatrist. Remember, mental illness is nothing to be ashamed of, and your psychiatrist should never act weird or make you feel less of yourself, no matter what you reveal.

      How often should I visit my psychiatrist?

      Once or twice a week should be okay, but if you feel you need to see your doctor more often, that is totally fine too. However, most hospitals will give you appointment dates, but if you feel it’s an emergency, you should totally go to the hospital, regardless of your appointment date.

      Seeing a psychiatrist is really not as scary as it sounds. Think about it like this: Take away the big scary word “psychiatrist’’ and what really just means is this; You are going to see a doctor who wants to and whose job it is help your mind get better.

      -Ugwu Uchenna

      Contributor, MANI

      5 Things to Know Before Attending Your First Psychiatry Appointment

      As a psychiatrist, I often hear from my patients during their initial visit about how long they’ve been putting off seeing a psychiatrist out of fear. They also talk about how nervous they were leading up to the appointment.

      First, if you’ve taken that major step to set an appointment, I commend you because I know it’s not an easy thing to do. Second, if the thought of attending your first psychiatry appointment has you stressing, one way to help tackle this is knowing what to expect ahead of time.

      This can be anything from coming prepared with your full medical and psychiatric history to being open to the fact that your first session may evoke certain emotions — and knowing that this is totally OK.

      So, if you’ve made your first appointment with a psychiatrist, read below to find out what you can expect from your first visit, in addition to tips to help you prep and feel more at ease.

      Come prepared with your medical history

      You’ll be asked about your medical and psychiatric history — personal and family — so be prepared by bringing the following:

      • a complete list of medications, in addition to psychiatric medications
      • a list of any and all psychiatric medications you might have tried in the past, including how long you took them for
      • your medical concerns and any diagnoses
      • family history of psychiatric issues, if there are any

      Also, if you’ve seen a psychiatrist in the past, it’s very helpful to bring a copy of those records, or have your records sent from the previous office to the new psychiatrist you’ll be seeing.

      Be prepared for the psychiatrist to ask you questions

      Once you’re in your session, you can expect that the psychiatrist will ask you the reason you’re coming in to see them. They might ask in a variety of different ways, including:

      • “So, what brings you in today?”
      • “Tell me what you’re here for.”
      • “How’re you doing?”
      • “How can I help you?”

      Being asked an open-ended question might make you nervous, especially if you don’t know where to begin or how to start. Take heed in knowing that there’s truly no wrong way to answer and a good psychiatrist will guide you through the interview.

      If, however, you want to come prepared, be sure to communicate what you’ve been experiencing and also, if you feel comfortable, share the goals you’d like to achieve from being in treatment.

      It’s OK to experience different emotions

      You may cry, feel awkward, or experience various kinds of emotions while discussing your concerns, but know that it’s completely normal and fine.

      Being open and sharing your story takes a lot of strength and courage, which can feel emotionally exhausting, especially if you’ve suppressed your emotions for quite a long time. Any standard psychiatry office will have a box of tissues, so don’t hesitate to use them. After all, that’s what they’re there for.

      Some of the questions asked about your history may bring up sensitive issues, such as history of trauma or abuse. If you don’t feel comfortable or ready to share, please know that it’s OK to let the psychiatrist know that it’s a sensitive topic and that you’re not ready to discuss the issue in further detail.

      You’ll work towards creating a plan for the future

      Since most psychiatrists generally provide medication management, options for treatment will be discussed at the end of your session. A treatment plan may consist of:

      • medication options
      • referrals for psychotherapy
      • level of care needed, for example, if more intensive care is needed to appropriately address your symptoms, options to find an appropriate treatment program will be discussed
      • any recommended labs or procedures such as baseline tests prior to starting medications or tests to rule out any possible medical conditions that may contribute to symptoms

      If you have any questions about your diagnosis, treatment, or wish to share any concerns you have, be sure to communicate them at this point before the end of the session.

      Your first psychiatrist might not be the one for you

      Even though the psychiatrist leads the session, go in with the mentality that you’re meeting your psychiatrist to see if they’re the right fit for you as well. Keep in mind that the best predictor of successful treatment depends on the quality of the therapeutic relationship.

      So, if the connection doesn’t evolve over time and you don’t feel your issues are being addressed, at that point you can search for another psychiatrist and get a second opinion.

      What to do after your first session

      • Often after the first visit, things will pop up in your mind that you wished you had asked. Take note of these things and be sure to write them down so you won’t forget to mention them next visit.
      • If you left your first visit feeling badly, know that building the therapeutic relationship may take more than one visit. So, unless your appointment turned out horrible and unredeemable, see how things go during the next few visits.

      The bottom line

      Feeling anxious about seeing a psychiatrist is a common feeling, but don’t let those fears interfere with you getting the help and treatment that you deserve and need. Having a general understanding of what kinds of questions will be asked and topics that will be discussed can definitely alleviate some of your concerns and make you feel more comfortable at your first appointment.

      And remember, sometimes the first psychiatrist you see may not necessarily turn out to be the best fit for you. After all, this is your care and treatment — you deserve a psychiatrist who you feel comfortable with, who’s willing to answer your questions, and who will collaborate with you to achieve your treatment goals.

      Dr. Vania Manipod, DO, is a board-certified psychiatrist, an assistant clinical professor of psychiatry at Western University of Health Sciences, and currently in private practice in Ventura, California. She believes in a holistic approach to psychiatry that incorporates psychotherapeutic techniques, diet, and lifestyle, in addition to medication management when indicated. Dr. Manipod has built an international following on social media based on her work to reduce the stigma of mental health, particularly through her Instagram and blog, Freud & Fashion. Moreover, she has spoken nationwide on topics such as burnout, traumatic brain injury, and social media.

      Psychotherapy is Alive and Talking in Psychiatry

      The title of Gardiner Harris’s front-page story in the March 6 New York Times was blunt: “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” For those of us who see our profession as a humanistic calling, this piece is likely to provoke a mixture of sadness and anger. After all, its depiction of psychiatric practice was one of grim, damage-control, in which maintaining the financial bottom line and keeping patients functional seem to be the prime directives. The main character in this sorry tale appears to be a decent soul, overwhelmed by the demands of his practice, and ashamed of his own therapeutic apostasy. The besieged and beleaguered psychiatrist, trained in the “old style” of in-depth therapy, describes his office as resembling “a bus station” and concludes that psychotherapy is no longer “economically viable.”

      The declining use of psychotherapy in psychiatric practice is unquestionably worrisome. Unfortunately, the New York Times article uses the anecdotal experience of one psychiatrist to create, at best, a partial picture of psychiatric practice, and at worst, a caricature that perpetuates a number of myths and misconceptions. Among the most injurious of these myths is that psychiatrists have essentially abandoned psychotherapy; that pharmacotherapy is something psychiatrists typically provide “instead of” psychotherapy; and that in the course of a 15-minute medication visit, there is little one can do for the patient’s emotional suffering, beyond referring him to a “real” psychotherapist. The article also perpetuates the popular but mistaken impression that pharmacotherapy is a rather crude and simple-minded intervention. Perhaps worst of all, this saga of an overworked psychiatrist may leave millions of readers with the fear that most psychiatrists are now “training” themselves not to get “too interested” in their patients’ problems.

      First of all, what is the reality of psychiatry’s use of psychotherapy in recent years? The Times cited a 2005 government survey showing that “just 11% of psychiatrists provide talk therapy to all patients. . . .” Presumably, this was a reference to the study by Mojtabai and Olfson,1 based on data from the 1996 – 2005 cross-sectional National Ambulatory Medical Care Survey (NAMCS). Indeed, the study found a decline in the number of psychiatrists who provided psychotherapy to all of their patients, from 19.1% in 1996 – 1997 to 10.8% in 2004 – 2005. The study also found that the percentage of visits involving psychotherapy declined from 44.4% in 1996 – 1997 to 28.9% in 2004 – 2005, which “. . . coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications.”

      So far, all this is in line with the New York Times piece. But the article failed to mention that most psychiatrists (59.4%) continue to provide psychotherapy to at least some of their patients.1 Moreover, when we read the discussion section of the Mojtabai-Olfson study, we find an important caveat. The design of their study required that “psychotherapy visits” had to be longer than 30 minutes and had to be “explicitly designated as a psychotherapy visit by the psychiatrist or office staff.” The authors added this telling observation:

      “Some visits likely involved use of psychotherapeutic techniques but were not classified as psychotherapy in the current analysis. Psychotherapeutic techniques can be effectively taught and used in brief medication management visits by psychiatrists and other health care providers.”1(p968),2,3

      Furthermore, the NAMCS survey did not examine the type of psychotherapy provided. As Mojtabai and Olfson1 note, “Examining the types of psychotherapy would be of special interest as there has been an expansion in the use of more structured short-term therapies in recent years.” Indeed, not all psychotherapy corresponds to, or necessarily requires, the classic “50-minute hour” associated with psychoanalytically oriented therapy. My colleague, James P. Gustafson, MD, has developed a form of “very brief psychotherapy” that sometimes involves 5- or 10-minute interventions. Surprisingly, these very brief encounters can be transformative on a very deep level, for carefully selected patients.3

      Indeed, while I am no fan of the 15-minute “med check,” the critical issue is not so much the available minutes as it is the deftness and sensitivity of the psychiatrist’s intervention. Faced with a patient who is experiencing a painful issue in her marriage or job, there is a good deal more we can do in 5 to 10 minutes besides saying, “Sorry, I’m not your therapist. That stuff is not in my bailiwick.” We can offer understanding, empathy, and clarification—and I believe most psychiatrists do just that, during a medication visit. Similarly, Dr Glen Gabbard has described how psychodynamic principles and an understanding of the patient’s urgent personal concerns are necessary parts of the much-maligned “15-minute med check.” He notes that “psychiatry has probably made far too much of a distinction between psychotherapy and pharmacotherapy in training and in practice. Psychotherapeutic skills are needed in every context in psychiatry because the same phenomena that emerge in psychotherapy—transference, resistance, countertransference, schema, automatic thoughts—appear in other contexts. . . . Psychiatry residents need to be taught that psychotherapeutic principles apply in all settings where psychiatric treatment is delivered. .”4

      The other unfortunate aspect of the Harris article is its implicit reinforcement of the “mind-body” split that has so bedeviled psychiatry for the past 50 years, as Tanya Luhrmann documented in her classic study, Of Two Minds: The Growing Disorder in American Psychiatry. Thus, pharmacotherapy is portrayed as something psychiatrists do “instead of” psychotherapy, rather than as part of an integrated and holistic form of treatment. But in my experience, many psychiatrists continue to provide such comprehensive medical-psychological care, although the Mojtabai-Olfson data do not tell us what percentage do so (M. Olfson, personal communication, March 8, 2011). In truth, there are often reasons—including cost-effectiveness—for preferring a “single provider” model of combined treatment. Dr Mantosh Dewan5 showed, for example, that when treatment requires both psychotherapy and medication, combined treatment by a psychiatrist costs about the same or less than split treatment with a social worker psychotherapist and is usually less expensive than split treatment with a psychologist psychotherapist. Furthermore, with respect to the treatment of major depression, there is reasonably good evidence that the combination of psychotherapy and medication works better than either treatment alone, at least in chronically or severely depressed patients.6,7

      Yet in the Times article, there is a not-too-subtle disparagement of pharmacotherapy. Our harried psychiatrist, estranged from his psychotherapeutic training, opines that “. . . there’s not a lot to master” in psychopharmacology, and that he often feels like “the ape with the bone.” It’s true that the kind of complexity involved in medication treatment is quite different from that of, say, psychoanalysis or object-relations theory. But psychopharmacology has its own complexity, if—to borrow a phrase from Woody Allen—“you are doing it right.” Quite aside from the innumerable drug-drug interactions one needs to sort through, there are the issues of medicating patients with comorbid illnesses, such as diabetes or heart disease; understanding how psychiatric medications affect the very young and the very old; monitoring potential metabolic effects of medications; and mitigating medication adverse effects without undermining otherwise successful pharmacotherapy.8

      Then there is the realm of medication’s “psychodynamics”—the hopes, fears, and fantasies the patient often attaches both to the physician’s prescribing a medication and to the particular drug prescribed. A failure to understand these often unconscious issues can spell disaster for pharmacotherapy. As Dewan has put it,

      “Some patients derive a psychological benefit from being given medications, because they consider it a caring, nurturing act that feeds their dependency needs or validates their suffering as genuine. Other patients may see the prescription of medications as an imposition of external control, or as a statement by the therapist that they are not strong enough to solve their problems by themselves. These feelings may contribute to noncompliance with both medications and brief therapy.”9(pp257-264)

      To be sure, given a 15-minute time slot, the harried psychiatrist focusing only on medication adverse effects is at a severe disadvantage—and so is the patient. Based on the principles of beneficence and non-malfeasance, one might argue that it is frankly unethical to limit an emotionally distraught or suicidal patient to such a procrustean time slot, if her medical and psychological needs demand more thorough evaluation and management. (Our beleaguered New York Times psychiatrist nearly fails to detect suicidal ideation in a patient who initially complained of “ADD” and, to his credit, winds up extending the session to 55 minutes.) Speaking of ethics: we should remind ourselves that there are still over 45 million Americans who lack health insurance, and that most patients with major depression do not receive any professional treatment10—never mind, psychotherapy.

      Finally, even the constraints of a 15-minute session are no excuse for putting off patients with comments such as “I’m not your therapist.” Like it or not, our patients often do not make a sharp distinction between “therapist” and “psychiatrist,” and we continue to be seen by them as sources of advice, comfort, and solace.4 As even our harried psychiatrist observed of his patients, “The sad thing is that I’m very important to them. . . .” But it really isn’t sad, Doctor—it is hopeful, and our patients should not be discouraged from seeing us as compassionate healers. After all, this is probably the image we had of ourselves when we entered this profession, our humanitarian ideals still intact.

      No, a brief medication check is hardly a substitute for the revered 50-minute therapy hour. But even in a 15-minute meeting, we can still engage in what Theodor Reik called “listening with the third ear.” Furthermore, we can and must convey to our patients that we are intensely interested in their problems.

      1. Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry. 2008;65:962-970.
      2. Castelnuovo-Tedesco P. The twenty-minute “hour”: an experiment in medical education. N Engl J Med. 1962;266:283-289.
      3. Gustafson JP. Very Brief Psychotherapy. New York: Routledge; 2005.
      4. Gabbard GO. Deconstructing the “med check.” Psychiatric Times. September 3, 2009. http://www.psychiatrictimes.com/display/article/10168/1444238. Accessed March 8, 2011.
      5. Dewan M. Are psychiatrists cost-effective? An analysis of integrated versus split treatment. Am J Psychiatry. 1999;156:324-326.
      6. Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression . N Engl J Med. 2000;342:1462-1470.
      7. Friedman MA, Detweiler-Bedell JB, Leventhal HE, et al. Combined psychotherapy and pharmacotherapy for the treatment of major depressive disorder. Clin Psychol Sci Pract. 2004;11:47-68.
      8. Jacobson SA, Pies RW, Katz IR. Clinical Manual of Geriatric Psychopharmacology. Washington, DC: American Psychiatric Publishing, Inc; 2007.
      9. Dewan MJ, Steenbarger BN, Greenberg RP, eds. In: Gabbard GO, series ed. The Art and Science of Brief Psychotherapies. Washington, DC: American Psychiatric Publishing, Inc; 2004.
      10. Wang SS. Studies: mental ills are often overtreated, undertreated. Wall Street Journal. January 5, 2010. http://online.wsj.com/article/SB10001424052748703580904574638750777038042.html. Accessed March 9, 2011.

      Acknowledgments—I would like to thank Susan Kweskin, Dr Glen Gabbard, Dr James Knoll, and Dr Mark Olfson for their helpful comments on earlier drafts of this piece.

      6 Awkward Things You Must Tell Your Therapist

      Source: Wonderlane/Flickr Creative Commons

      People have all different levels of comfort when it comes to talking about difficult things with their therapists, just as people can vary greatly within their real-world relationships. We all know those people who are all too willing to dive into a potentially difficult conversation with gusto—they’ll send a soup back a second or third time if it’s not exactly the right temperature. At the other end of the spectrum, others will eat a cold soup—even with a hair in it.

      For those who have anxiety around potentially awkward situations, and are experiencing something difficult within their therapy, therapy itself is the very place to work through that. In fact, not only are certain difficult topics important to bring up in the therapy setting, but that setting itself can provide the ideal place to talk not only about the topic but why it’s so difficult for you. It’s very important to remember that you can get the most out of therapy when you bring up what you are truly thinking and feeling—even when, or especially when—it involves the therapy itself. If you don’t want to say it, you can bring in a piece of paper to have the therapist read, spelling out that you need to have a conversation that’s difficult. Here are six common topics that can be tough to talk about, and why you’re doing yourself a favor if you can put them on the table.

      1. There is an issue or behavior you haven’t revealed to them. It’s quite common not to tell your therapist your deepest, darkest issues right away. And it can be fine to begin therapy talking about one main issue and being slow to reveal something going on deeper under the surface until you feel more comfortable. But wait too long, though, and you’re just wasting time and preventing yourself from working on it or understanding how significantly it may be connected to the issues you are talking about. Maybe you’re okay talking about your depression symptoms but have never told anyone about childhood sexual abuse, and can’t seem to bring it up even with your therapist. Or maybe you’ve ommitted just how much you drink, how often you take painkillers, your problems with binge-eating, or the fact that you have extreme road rage. Whether it’s because it’s embarrassing, scary, or shameful to talk about it, you eventually need to—so that the therapist can get a fuller picture and you can really start working on the root of the problems, rather than the more surface-level symptoms that you might be hiding behind.

      It is worth noting, of course, that there are some times where your therapist might be put in a position of potentially having to report a situation to get further help. Almost always these involve imminent danger to the health or well-being of you or another specific person. Your therapist should have spelled all this out clearly for you during the informed consent process before you started therapy. If you are unsure or concerned, you can broach the topic generally to get further clarity about confidentiality limits before giving details.

      2. They said something that has upset you. Maybe it was an offhand remark that you felt minimized what you were working on or a way that they interpreted something you said that you found to be condescending or unhelpful. Ideally, you would bring up your reaction in the moment—such honest and open discussion of those interpersonal interactions and emotional responses can be the stuff that great therapy is made of. But if you didn’t say anything at the time and you find that it is sticking with you and continuing to annoy or upset you, it can still be extremely useful to bring it up, perhaps even more so. For one thing, your therapist can better understand how and why they erred, and get a fuller picture of your emotional make-up that they might not have realized before. For another thing, it can prevent similar situations from getting in the way of the therapeutic process and can help build an even more emotionally intimate relationship.

      3. You are unsure if you are making progress. For many people, especially if they are conflict-avoidant, one of the most difficult conversations of all is to express doubt or dissatisfaction about the therapeutic process or, even more specifically, the therapist themselves. A large percentage of people would rather just stop seeing the therapist than have this conversation and try to recalibrate whatever doesn’t seem to be working. And of course, this is an understandable reaction. Some therapists are simply better than others, and even when competence is not an issue, the match can be—certain styles and theoretical orientations and personalities are more bound to click with your needs than others are. But other times, feeling stalled can be part of the therapy process itself, as there’s a certain truth to the fact that sometimes you must feel worse before you can get better. This is virtually a guarantee if you are reopening old wounds or spending a lot of time talking about things that sadden or anger or frighten you. And to flee the therapy at that crucial point can be shooting yourself in the foot—doing the work without sticking around to get the reward. So bring it up instead, and see where it goes.

      4. You are having difficulty with payments. Money and financial arrangements can often feel like an annoying pest intruding upon the therapy at best or a serious stressor that threatens your ability to be in therapy in the first place at worst. Many therapists dislike dealing with the financial arrangements as much as you do—that’s why we became therapists and bypassed majoring in accounting. But all too often, a client may be having trouble coming up with payments, and by not being direct about it, the therapist has no idea. The client then digs themselves into a deeper and deeper hole, where they might be prone to break off the relationship without warning or default on payments—neither of which is going to help them feel better.

      5. You feel they’re not getting something. Maybe you’ve tried explaining a relationship or a feeling or a habit of yours, and instead of feeling understood and validated, you’ve felt like your therapist is misconstruing what you’re saying. Or maybe they’re unfamiliar with a certain aspect of what you’re going through at work because they have no clue about your industry, or you feel like they’re minimizing something that really bothers you. Give them a chance to get a clearer picture by talking to them about how you’re feeling unheard about it. The more the therapist realizes that they’re missing the mark, the harder they can try to really understand and do the work with you that you deserve.

      6. They’re doing something that you find disconcerting. No therapist I know will ever admit to being the one who takes phone calls during sessions, is routinely late, nods off, glances at the clock obsessively, or reveals too much about themselves. And yet I’ve heard clients say that they’ve actually experienced plenty of this in past therapeutic relationships! Of course, it is reasonable if you experience one of these transgressions that you might want to end the therapy without having a discussion about it. But if you’re otherwise doing good work together, don’t let it be tainted by not bringing the issue to the therapist’s attention. That will give you the opportunity to see if it is just a singular oversight that can be corrected, or if it’s part of a more problematic pattern that means they’re not the therapist for you. If you never bring it up, you’ll never know—and you risk losing the investment you’ve already put in.

      Andrea Bonior, Ph.D., is a licensed clinical psychologist, speaker and media commentator. She is the author of the book Psychology: Essential Thinkers, Classic Theories, and How They Inform Your World and other books.

      5 Essential Things to Tell Your Therapist If You’re Highly Sensitive

      It’s normal to get sad, depressed, or anxious at times. This is true for everyone, including those of us who are highly sensitive. But sometimes, depression can sink in and take hold of your life. If your depression has become a permanent inner state or if you’re feeling hopeless all the time, it’s probably time to ask for help and visit a psychologist, psychiatrist, or therapist.

      (Not sure? One way to evaluate if you should get help is going through the Burns Depression Checklist. If you score higher than 25, you should know that getting professional help is a must.)

      Of course, not all highly sensitive people (HSPs) suffer from depression, but it is fairly common — and there’s no shame if you do. If you’ve reached the point of feeling hopeless or desperate, talking to a therapist is the most important thing you can do.

      And when you make an appointment to visit a psychiatrist — whether for the first time or not — remember: Not all psychiatrists have had highly sensitive patients before. But there are things you can do to make sure your treatment is a positive, helpful force in your life.

      Here are five things that you should tell to your therapist.

      What to Tell Your Therapist If You’re Highly Sensitive

      1. I’m a highly sensitive person.

      Though it may seem like an obvious thing to say, it’s important to remember that it’s only between 15 and 20 percent of the population who are highly sensitive. This means that of all the patients your doctor sees, probably 8 out of 10 are not as sensitive as you.

      Be frank and open about how deeply you feel your emotions, how sensations can drive you nuts, and how depression is making you feel — both emotionally as well as in your physical body. For me, emphasizing this has been a game-changer because it means that my doctor is more careful when prescribing medication. We take the side effects into consideration, as well as the right dosage and the progress I should make as an HSP.

      2. This is what my real current state looks like.

      As an HSP, it’s quite easy to feel ashamed of describing how depression can make you feel — because frankly, it affects us more deeply than others.

      For example, depression has many obvious symptoms like:

      • Fatigue
      • Loss of interest in things you like
      • Loss or increase of appetite
      • Feeling sad all the time

      But for a highly sensitive person, depression can look like many other things. Often, it feels physical. And your doctor should hear you say the stuff you’re experiencing. It’s your appointment, and it’s you she’s treating, so let her pay attention to your real feelings and sensations. For example:

      • I feel like my skin is on fire all the time.
      • After crying, I feel a strange pain in my ears.
      • My sadness is giving me cramps in my legs.
      • My hands have been going numb at night.

      You may feel crazy while saying things like these, but I’ve learned that I’d rather have my doctor know the wild stuff I experience as a highly sensitive person than try to pretend I’m someone else. As an HSP, you feel the sadness and the sorrow depression brings, but bodily sensations, sounds, and pain can be even more distressing than the sadness itself.

      3. I’m very sensitive to medication and its side effects.

      The first time I took antidepressants, I was not prepared for the side effects. I’m absolutely glad that I took the medication and that I responded well to the treatment, but wow, those side effects. As an HSP, they were brutal:

      • “Mild nausea” felt like “I want to throw up 24/7.”
      • “Possible fatigue” felt like “I can’t move a finger.”
      • “Possible headaches” felt like “Please chop off my head.”

      After my first experience with such issues, I learned my lesson well. I understood that I had to tell my doctor how sensitive I was to medication and that I was aware of how my body feels all the freaking time!

      Telling the truth about extreme sensitivity makes things much easier as you to start psychiatric treatment. You will probably be given a smaller dose, slowly building up tolerance and making sure that you’ll stick to the medication. Remember, you want the benefits of the meds, so be open about your condition.

      4. This is how treatment is making me feel.

      For the first weeks of treatment, it’s good to keep a journal. Write down all the ups and downs and all the feelings and sensations. It’s a good way to track progress. Personally, I’ve learned to send the daily journaling to my doctor. She often doesn’t respond and she doesn’t have to, but it’s been a good practice because sometimes she’s noticed important patterns and has taken medical decisions based on them.

      The importance of honesty with your doctor cannot be overstated. As HSPs, we’re used to being misunderstood, but in therapy, you don’t have to pretend to be someone else. So let your doctor or therapist know how you feel — especially when first starting your treatment.

      5. I think this is not working.

      Medical treatment for depression and anxiety can be extremely helpful when it’s needed. It can make you feel so much better and return to a normal life. But sometimes treatment doesn’t work as expected. What should you do then?

      This happened to me recently when a new medication just didn’t work. I took a pill every single night for more than three months and kept expecting better results. The problem was that, as we sensitive people often do, I started second guessing myself:

      • Am I overreacting?
      • Am I making things up?
      • Am I well but focusing on the wrong sensations?
      • Is it all in my head?

      Look, medication is meant to work. It should make a significant difference and bring relief to your life. The same is true of evidence-based therapy techniques like cognitive behavioral therapy, as long as you are doing the practices. So if it’s not working as you expected, it’s time to open up and be frank with your doctor.

      In my case, I called her and told her that it was taking too much energy just to pretend that I was feeling better and that I needed something else. Her reaction was to immediately consider what we could change to improve things.

      And it worked! But it required me to raise my voice and express my feelings.

      Therapy Is the Time to Speak Up

      Depression is not how you’re meant to live your life. Sadness is not meant to be your permanent inner state. Feeling sick is not how you should live. Get help, find a professional who can help you, and give you meds if necessary.

      But remember that after you get help, it’s your turn to help yourself by talking honestly about all the details that you experience. It’s those details that matter — at least for an HSP. So make them count!

      You might like:

      • Why Highly Sensitive People Get Mentally and Emotionally ‘Flooded’
      • Therapy Can Be a Nightmare for HSPs (But It Doesn’t Have to Be)
      • 21 Signs That You’re a Highly Sensitive Person
      • 14 Things Highly Sensitive People Absolutely Need to Be Happy
      • 13 Problems Only Highly Sensitive People Will Understand

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      Going to see a psychiatrist? Make sure you are ready! Before you come in for your first psychiatrist appointment get prepared by answering the following questions. If you do this, we will spend less time recreating your history and more time talking about the reasons you have come in for the psychiatric appointment. If you are seeing a psychiatrist for the first time try to answer these 16 questions before your appointment. You may find it helpful to write down your answers and bring them to the appointment.

      Download and print out a copy of the questions by entering your email here:

      If you haven’t yet found a psychiatrist first read the post: 8 Questions You Need to Ask to Get the Best Psychiatrist! This post will also give you tips on how to assess the fit between you and the psychiatrist and make sure it will work for you.

      Questions to answer before your psychiatrist appointment:

      • Why are you are coming in for an appointment now?
      • What are the particular things that are bothering you?
      • What would you like help with?
      • How far are you from your baseline?
      • How would you describe your normal personality? Are you more a cup half-full person or cup half-empty?
      • When did you start feeling bad?
      • When was the last time you felt happy?

      Seeing a psychiatrist for the first time: Know your family history

      Try to learn as much as you can about your family’s medical and psychiatric history. In some families, mental health is a taboo topic and not openly discussed. Try to think if there is one person who may be easier to talk to and ask them.

      Knowing your family history before your psychiatric appointment can help us to come up with a more accurate diagnosis and plan.

      • Does anyone in your family have any psychiatric history?
      • Is anyone seeing a psychiatrist? Have they been hospitalized?
      • Has anyone been treated with medication? If so, which medicine and was it effective?

      Psychiatric appointment: Your past history

      If you are going to see a psychiatrist, think about your own past mental health history. If you can’t remember details, ask your family if they remember. You can also contact your previous psychiatrist to see if they still have records.

      • Have you seen a psychiatrist before? If you have, find out their contact information (especially their fax number!).
      • Have you been in therapy? Was it helpful? What did you like or not like about it?
      • Have you been treated with medication before? Was it helpful?

      If you are struggling to come up with your medication history see if you can get it from your pharmacy. I have had people be able to get a medication printout for the previous 10 years. Although it can be cumbersome to sort through, it can provide valuable history.

      Going to see a psychiatrist? Write out a timeline!

      Write up a general timeline for your history and the medicine you have tried. Details to include on the timeline are:

      • Approximate dates you took medication and why you took it.
      • What were the doses of the medication?
      • Were there any side effects? Any benefits?

      If we have a list of your past medications, we can come up with a more accurate picture of what works for you and what doesn’t.

      What you need to do before seeing a psychiatrist:

      Don’t get me wrong. You don’t need to have everything figured out and conceptualized before your first psychiatric appointment. The more questions from this list that you are able to answer before you come in, the more time we get to talk about why you are seeing a psychiatrist. Its win-win!

      Do your best to organize your thoughts but don’t stress out about it. It doesn’t need to be perfect. You may find it helpful to write down your answers and bring them to the appointment.

      How well do you know your medical history?

      Do you know what the plan is to manage your medical diagnosis? What is your medication is for? What can you do to take charge of your health?

      You need to be your #1 advocate and that requires you to have a good knowledge of your medical history. Download a form of the questions you need to know by entering your email here:

      Looking for additional mental health resources?

      Check out the Mental Health Bookstore and Resources page to get helpful options.

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