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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Medusa on August 16, 2002, at 23:34:36
So ... how do therapists decide who to help? I think I must not ask for help appropriately or accurately or convincingly - or therapists and pdocs just have very different measurements than I imagine.
Posted by Dinah on August 17, 2002, at 7:16:26
In reply to How therapists decide who to help, posted by Medusa on August 16, 2002, at 23:34:36
What do you mean, Medusa? Are you having problems finding a therapist?
My understanding is that therapist decide to accept a client based on whether they think they, as clinicians, can help this particular client, and are almost required to refer out those they don't feel qualified to help.
Posted by Ted on August 17, 2002, at 10:00:47
In reply to Re: How therapists decide who to help » Medusa, posted by Dinah on August 17, 2002, at 7:16:26
Dinah & Medusa,
> My understanding is that therapist decide to accept a client based on whether they think they, as clinicians, can help this particular client,
Here is Silicon Valley, there is such a shortage that therapists & pdocs really get to pick & choose. My pdoc interviews patients to make sure they won't take too much of his time before he will accept them as new patients. I referred a coworker's daughter, who has bipolar-I, and the pdoc said no -- her case was too severe. It's not that he couldn't help, more that his results wouldn't be stellar, I think.
> and are almost required to refer out those they don't feel qualified to help.
Ha ha ha ha ha ha ha ha ha ha ha ha ha ha
ha ha ha ha ha ha ha ha ha ha ha ha ha ha
ha ha ha ha ha ha ha ha ha ha ha ha ha haDinah, You're FUNNY! :-)
We have such a shortage of pdocs that the unscrupulous ones don't even get complaints.
Ted
Posted by mist on August 17, 2002, at 10:14:24
In reply to How therapists decide who to help, posted by Medusa on August 16, 2002, at 23:34:36
Many therapists seem to decide based on how much total income they can make from a particular client. What is the client's ability to pay (according to the therapist), at what fee level, insurance, likely duration of therapy, etc.
> So ... how do therapists decide who to help? I think I must not ask for help appropriately or accurately or convincingly - or therapists and pdocs just have very different measurements than I imagine.
Posted by Phil on August 17, 2002, at 10:32:25
In reply to Re: How therapists decide who to help » Dinah, posted by Ted on August 17, 2002, at 10:00:47
They look out their window and see what kind of car your driving, do a background and credit check, determine if you might be the type that begs for samples, call previous pdocs to see if you're nuts, put their finger in their mouth, walk outside to see which way the winds blowing, call their astrologer and psychologist and with that info..make an enlightened decision.
Then a short interview..what drugs have you tried?
a. Marijuana, mescaline, mushrooms, cocaine.."Stop. How did you feel on coke?"
a. Focused. "Good, you are ADHD. You look nervous, any anxiety?"
a. Yes, I go to Mexico every other month for Xanax, Valium and Klonopin. "You take all three at once?"
a. Only if we're having a kegger. Usually I take Xanax and sell the rest.
"Remind me to keep you away from my sample closet."
a. Uh, where is it so I don't accidentally go there thinking it's the bathroom?
-Question ignored-
"What do you do for fun?"
a. Turn off the light switches and check them 20 times before I leave the house.
"I'll have to look that up. Are you homosexual?"
No, but if it will help, you look nice.
"Are you heterosexual?"
a. Is this a joke? Most of my sex is self-administered.
"How are you sleeping?"
a. On my side motely.
"Do you believe in God?"
a. I don't understand.
"Do you have hallucinations or hear voices?"
a. Just the time I smoked some hydro.
"Have you smoked marijuana long?"
a. As long as I can get it.
"It could interfere with your treatment."
a. No, the treatment might interfere with the buzz.
"I must admit, I smoke, too..anything, you know, around?"
a. I think we could work it out.
"Terrific, I'll charge $22.00 an hour."
Posted by ShelliR on August 17, 2002, at 10:33:29
In reply to Re: How therapists decide who to help » Dinah, posted by Ted on August 17, 2002, at 10:00:47
Hey Ted,
I got that too. Treatment resistant depression. I've had pdocs say on the phone that they don't want to take on such a difficult CASE. (great to think of yourself as a CASE, anyway) And they didn't say they couldn't help me, just that they didn't have the time or energy it would take.
Jeez, when you're already fighting for life.
Shelli
p.s., I do know one dpoc who I met with and thought was very strange and didn't go back. (like he has both voice mail and a beeper, and he answers his regular, non-emergency phone when he is in session and then gets annoyed that you are interrupting him.) He's called me several times since to say he wants to try to help me. So maybe for some, I can be looked at as a challenge.
Posted by mist on August 17, 2002, at 10:49:58
In reply to Re: Here's how it's done!, posted by Phil on August 17, 2002, at 10:32:25
Posted by Dinah on August 17, 2002, at 10:56:59
In reply to Re: How therapists decide who to help » Dinah, posted by Ted on August 17, 2002, at 10:00:47
Around here, there's a waiting list for pdocs, and the better ones might pick and choose their patients based on personal preference.
But therapists are another story. We're a psychological backwater here. Most local therapists and psychologists have apperently not heard of Asperger's in adults, and the only DBT offered locally is inpatient.
People tend to view therapy with suspicion, or solely in terms of marital counseling, insurance reimbursement is limited to a short number of sessions, and overall income level is not high. Therapists face enormous turnover and most therapy is brief. So... most therapists are constantly anxious to fill hours. And most would only turn away a client if they thought they were over their heads. There might be a waiting period for the "best" therapists, but I don't think any aren't taking new clients or anything.
So, perhaps I'm naive, but the therapy situation around here doesn't seem to be that bleak.
And DON'T TELL MY THERAPIST ABOUT THE WINDFALL AWAITING HIM IN YOUR AREA. I worry enough about being losing him as it is.... :)
Posted by judy1 on August 17, 2002, at 12:11:37
In reply to Re: Here's how it's done!, posted by Phil on August 17, 2002, at 10:32:25
That was REALLY funny Phil (and unfortunately true, even in So. Cal). I really research my shrinks and therapists- although I prefer shrinks who do therapy (not too many of those around) and then i go to the ones whose expertise match my disorder. I'm really fortunate because I live in a University town, and many of the docs are cutting edge type and seem to love challenges. So maybe by doing all that research, I've haven't gotten in the situation of being turned down. By research- I call and see what area of practice they specialize in, I try to get as much info on the net, look at any research papers, etc. I understand the 'average' HMO type shrink/ psychologist probably don't fit that criteria, just wanted to emphasize that I look at the academic ones (and usually land up paying myself, although my therapist(who is incredible) is covered by my insurance. take care, judy
Posted by Phil on August 17, 2002, at 14:11:38
In reply to Re: Here's how it's done!, posted by judy1 on August 17, 2002, at 12:11:37
I work 2 blocks from University of Texas(50,000 students or more) and live about a mile from campus.
I hear of people having trouble getting stims or benzo's but it's no issue here. My psychiatrist was a pharmacist; now she's a psyc. and neurologist.
Hope she doesn't decide to go to law school!
Her and her husband have their own little office out of which tremendous amounts of money change hands. Good people though. They actually have older cars that are not fancy, just plain old transportation. That's the way all of Austin used to be, really laid back.
Now there's a jerk at every stop light driving a Lexus, BMW, Kompressor, Suburban(always women-always on a cell phone), four wheel drive four door diesel Ford pickups, Range Rovers, Audi's that only a very short person could fit into and still couldn't carry a bag of groceries. I park in a parking garage at work and the roar of those HUGE Ford diesel's is ridiculous. Getting thru all those trucks and Suburban's makes me nuts.
I'm glad that these people raked in the bucks during high techs and the stock markets boom; now I wish they would go back to wherever they came from. (Sorry, a lot of Californians)Sorry about the ramble.
Posted by judy1 on August 17, 2002, at 14:20:58
In reply to Re: Here's how it's done! » judy1, posted by Phil on August 17, 2002, at 14:11:38
Yes, we are an obnoxious bunch of liberal tree-huggers but we're really nice people who have love affairs with our cars and cell phones. I know someone who moved to Austin, he said it was beautiful but hot. I would love to visit sometime. Did someone tell you bad stories about California when you were little? :-) take care, judy
Posted by judy1 on August 17, 2002, at 14:27:00
In reply to Ouch, I guess I won't tell you what I drive:-) » Phil, posted by judy1 on August 17, 2002, at 14:20:58
are the small Hummers- like the Humvees but get 10mpg instead of 5. Very cool looking, and a 2 month wait for a $55k SUV- so keep looking for the ex-Californians- they come in grey and yellow :-)(the car, not the Californian) - judy
Posted by Phil on August 17, 2002, at 14:44:18
In reply to P.S.- the latest craze in cars here- Phil, posted by judy1 on August 17, 2002, at 14:27:00
I'd wager that 98% of 4 wheel drive vehicles have never even seen the shoulder of a highway.
Oh, I saw one of those super long limos the other day, it was a Ford Excursion stretch. What next?
I guess if you earned the money or stole it, you can drive what you please but if I ever almost get smashed again by a 5'5" lady driving a Suburban talking on the phone, I'll get my license to carry. Actually, I've pretty much tamed the road rage thing seeing that the other person could shoot you. Plus, how do you overcome depression while being angry at traffic?
Just don't get me started on Bush letting commercial semi's out of Mexico on our roads. I thought it was a joke.
Posted by Ted on August 17, 2002, at 20:36:58
In reply to Re: P.S.- the latest craze in cars here- Phil » judy1, posted by Phil on August 17, 2002, at 14:44:18
Hey Phil,
> I'd wager that 98% of 4 wheel drive vehicles have never even seen the shoulder of a highway.
Nah -- in Silicon Valley, CA, I'd say it is closer to 99.99%, with the sole exception of those being run off the road by a cell-phone user (or a woman putting on makeup during the morning commute -- sorry ladies but it happens all too often).
The difference with me is that I bought a 1988 Nissan Pathfinder that already had 138,000 miles to use just for offroad, usually 4x4 driving. But that's about all I use it for. Even still, at 20 mpg, it is more economic than a lot of cars.
> you can drive what you please but if I ever almost get smashed again by a 5'5" lady driving a Suburban talking on the phone, I'll get my license to carry.
This is so common here it isn't even worth noting. Only here it is the Lexus, Mercedes, Cadillac, etc. SUVs and the women are usually 5'0' Chinese* mommies rushing their kids to school or daycare while talking on the phone.
*Not mean't to be sexist, racist or nationalistic, but an observation whose frequency is worth noting.
> Just don't get me started on Bush letting commercial semi's out of Mexico on our roads. I thought it was a joke.
Tires smoother than a baby's behind. Really.
Ted
Posted by judy1 on August 17, 2002, at 23:09:04
In reply to 4 X 4s -- » Phil, posted by Ted on August 17, 2002, at 20:36:58
I would be all upset if I wasn't the 5'5" woman in the SUV (I refuse to put the make down and fulfill all your expectations) on the cell phone driving my son to school and baby to Mommy and Me and maybe I did brush my hair but I certainly did NOT put on make-up when I went off the shoulder of the road :-)- judy
Posted by Medusa on August 18, 2002, at 1:41:42
In reply to How therapists decide who to help, posted by Medusa on August 16, 2002, at 23:34:36
Me again. Guess I'll have to upgrade that SUV and get some high connections in the Netherlands and ... or I could just move to Silicon Valley and set up a practice without a license. You guys are hilarious.
What I meant about who therapists decide to help was, once you're in therapy ... how do shrinks decide who's priority. What makes them so sure that they can go over 20 minutes into my session with their previous patient, because "he's in a lot of pain", but cut my sessions short.
[I'm not looking for a therapist at the moment. I have to meet with DH's 'family coach' (or something like that - she's a therapist but he doesn't call her that - he went looking for coping methods for living with a depressed person and ended up hashing out a lot of his own family stuff) in September, and then she wants to meet with DH and me together, but I don't plan to see her on a regular basis.]
But I've had terrible experiences with therapists of all sorts, enough to make me think it's me, something I'm doing to +make+ myself low-priority on their list.
Possibilities:
-I shower and otherwise try to pull myself together to get to the appointments, which I get to on time, and I try to pull myself together enough to get work done during the session. Often that's been the ONLY thing I've accomplished during the entire week.
Example: One receptionist read off her computer screen to me (via phone) that on the intake form I was listed as "high functioning" (oh boy, can get out of bed to use toilet!) and therefore I shouldn't expect a therapist to call me to schedule an initial appointment for a few months yet.-Sometimes I've been too entertaining, which could be a coping mechanism, but I expect therapists to see through this and deal with the pain.
Example: One therapist seemed to really admire me and said "your life is like a parade!" (her life seemed pretty dull, from what little I could gather, but I wasn't there to be admired), and the therapist who said that sessions with me were "better than a movie".-I don't ask for enough help. (Is that how the coddled patients get help? by asking for it?)
Example: in uni, I _did_ have a therapist (an intern) who came in early a few mornings to give me an extra session. She was an ice queen, but she was the first person who convinced me that someone really believed me.-I don't ask enough questions.
Example: one therapist said that my insurance would cover ten sessions. What she didn't say was that she was out of my plan's normal coverage and was obtaining coverage through her colleague, and that if I'd seen her colleague, the insurance would have covered a lot more visits, but that she didn't feel comfortable with her loophole for more than a unit of ten sessions. If I'd known the rules of my own insurance plan, going in, this wouldn't have happened. As a goodbye, when I told her she wasn't worth 120/hour or whatever, she told me "you should find help somewhere, because your family is really f_cked up." Heh, ya think?-Some therapists are really just loopy. (But not enough to explain this pattern I sense.)
Example: the therapist who canceled sessions, then accused me of missing them; he also told me that bulimia wasn't too bad a problem to have, it wouldn't kill me, and he had patients with much worse problems. He also suggested that I go to church. When I complained about this to a university advisor, the advisor said it was a good idea! End of story, a bit later I read in the New Yorker that this shrink was the therapist for the girl who stabbed her roommate to death and then hung herself in their dorm. No wonder! Too bad we hadn't known each other - we could have taken on the therapist instead of her roommate.Anyway, any input/experiences/suggestions welcome ... I'm not going to see another shrink until I get this worked out a bit, otherwise I'm throwing money into the wind and getting spit on.
Posted by Dr. Bob on August 18, 2002, at 9:25:04
In reply to Geez Ted, posted by judy1 on August 17, 2002, at 23:09:04
Posted by judy1 on August 18, 2002, at 10:19:28
In reply to Re: How therapists decide who to help, posted by Medusa on August 18, 2002, at 1:41:42
And I'm sorry for the diversion, we do seem to go on tangents here occasionally :-). I think the most critical lesson I've learned is NOT to minimize my problems- shrinks/therapists aren't mind-readers, but like you I can give a pretty good 'normal' act and still be in a lot of pain. Therapists do go over in sessions when people are suicidal, etc.- think if you were in that person's place and be thankful you would get the extra attention. I guess my best advice is to be really firm that you are in pain and expect the help you need and stress how you are willing to work with the therapist to achieve that. (They love that). Take care, judy
Posted by judy1 on August 18, 2002, at 10:20:24
In reply to Re: thanks for responding in a civil way (nm) » judy1, posted by Dr. Bob on August 18, 2002, at 9:25:04
Posted by judy1 on August 18, 2002, at 11:06:19
In reply to Hi Medusa, posted by judy1 on August 18, 2002, at 10:19:28
"Some therapists are loopy"- well that's an understatement. We can share stories- after my shrink crossed boundaries I was referred to another one who just got arrested for drugging a couple of his female patients and having 'relations' with them- and this is a nationally known author/shrink. So yes, they are human and some not so human :-), but it sounds like you have had some bad luck- I went through 14!!!until I found mine. You mentioned a University, are all these therapists through student health? Does your school have a Dept. of Psychiatry? If so, go to the chairman's secretary and ask her/him who they would send their daughter to if she was experiencing a psychological disorder. That's been a good lead for me once. I truly hope your luck changes and you find someone you 'click' with. Take care, judy
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