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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by gardenergirl on August 4, 2004, at 9:38:44
So, I went to see a pdoc for the first time ever. I was feeling like my GP and I were in over our heads in managing my meds (I'm a poet and I don't know it.) Fortunately, since I kind of picked her at random, and she was the only one out of about a dozen I called who is accepting new patients, she is comfortable prescribing MAOI's.
However, she was pretty, er, blunt. Kind of mean, actually. She did agree that there is a lot in my history which is best worked through with psychodynamic therapy, but she also said "insight is great, but at some point you need to *do* something." Okay, I can agree with that.
But she also said I am acting like a child in my marriage and in life, basically, and it was time I grew up and got my act together. Yikes! Now, in some ways, I can see perfectly how she would come to this conclusion. But jeepers, we just met! It didn't feel good to hear it. And it kind of goes against the regression that is happening right now in therapy.
So anyway, she increased my Nardil, and I am going to see her once a month for medication management. She also is going to work with me on changing some bad habits, like procrastination. I know that my T would not be the type to work with me on something like this, so I feel okay about working with her on this. But I wonder how it will go to have essentially two T's for a while, who are doing two very different things...will it be a good adjunct? or will it run counter to what I've been doing so far?
And another question...I didn't get a chance to talk to my T about getting a pdoc before he went on vacation because I actually got an appt. with her the day after I called. (can you believe it?)I am worried about how he will react. I suppose he will say it can't hurt, but that it is not what he thinks will be helpful. I don't know. I feel sneaky, although it is not intentional.
For those who see a pdoc and a T, how does it work for you? Any conflict between the two? And what do you think about her attitude?
Thanks,
gg
Posted by Dinah on August 4, 2004, at 9:54:24
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
My pdoc does meds management only.
The pdoc from H*ll threw in some therapy as well. It was a disaster. He was abrasive and his style didn't work *at all* with me. My mental health improved appreciably when I left him. And with that experience in mind, I fired biofeedback guy as soon as it became obvious that his style was similar.
My therapist was ok with the evil pdoc providing a bit of therapy because he recommended this guy, worked with him regularly, and liked (?!!!!!) him. But he is very clear that any other mental health support I seek should *not* involve therapy. That you can only have one therapist at once. I've always found it rather unreasonable of him, but that's his rule.
Posted by gardenergirl on August 4, 2004, at 10:03:27
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by Dinah on August 4, 2004, at 9:54:24
Dinah,
That rule is what I am worried about. I was taught that one at a time is the "rule" too. I know he won't terminate me because of it, but I just feel bad. Ugh. I don't want to stew about this for two weeks. At the time I thought seeing a pdoc while he was gone would be helpful. :)Thanks for your input.
gg
Posted by lucy stone on August 4, 2004, at 10:24:43
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
I'm not on medication right now although I have been in the past. I'm very anti-medication for me although I am not against it in general. I have had bad experiences before and I have a past history of addiction that makes me leary. My T occaisionally brings it up and he has a pdoc that he would refer me to if we decided I needed it despite my reservations. I asked if he would call her first and go over my case with her and he said he would, but he also said she would ask me a bunch of questions which is of course what she should do. I am very doctor-phobic which is part of the reason I resist this, but another reason is what you have described in your post. I don't want to run the risk of another mental health profession messing around in my head. It's hard enough to work with one perspective. I suspect that either the pdoc my T would recommend would not so or she did it would not be in a way that undermines my current therapy, but of course you never know for sure. Perhaps you can see this pdoc for now and when your T comes back talk to him about what happened. He might have someone else to suggest who is more compatable with your T's style.
Posted by B2chica on August 4, 2004, at 10:39:02
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
My goodness, that was pretty blunt! i think that would be a little blindsiding for me.
-however, not suprising. my pdoc is pretty much the same way. I see one pdoc but actually saw his wife when i was in the hospital, she saw me once for 15 minutes and the next day she layed my cards out on the table -it almost took my breath away but WOW was she right on the money...i don't think anyone has EVER called me on the carpet the way she did.ANYway, it's funny you should talk about this cuz i had my T appt yesterday -it went quite well- and we touched a little bit about this, and he said basically pdoc's tend to be much more on the physiological end of things. They deal with chemicals and prescribe meds. Where as T's deal more with internal (locus of control if you will) factors. Not the biological but how you deal with the biological. My T and i both agree that it is good to have both.
From what i've seen, IMHO i am not comfortable with a "talk therapy" with my pdoc, only with my psychologist. some pdoc's do both (or say they do) but they are much more focused on etiological reasons (cause of "disease"). Infact, the reason i brought this subject up was last time i saw my pdoc he said that he didn't believe in digging up the past, that you 'can't change it so why go there', and would only focus on the here and now and how to get me through that. Before i mentioned that i asked my T what his view on therapy was (yes i'm just now asking that...) but he replied that yes the present is very important but that most of the reason we are who we are is stemmed from our life as a whole, so he believes much in 'covering the bases'. (which by the way is Exactly what i wanted to hear...test #3 he passed with flying colors!!)So here's the layout, i see my T once a week to talk about pretty much Anything, the only thing he doesn't do is prescribe meds. But he'll even talk about them like what he's heard about their effects and such. My pdoc i see about once every 2 or 3 months just to check on my meds and to get script filled if needed. I also see my GP about once every 2 months...(mostly cuz i LOVE him) but he's kinda both, ok...here i go...but, he makes me feel safe both physically and emotionally safe, i trust him/his opinions 150%, he protects me physically -takes care of me in a way, but he's also a little like a T. i tell him all about my pdoc and T, and if i do or don't trust them, he knows what my SI really is all about and i've never told him...he knows about my eating disorder issues... and he Never, Never judges me. he looks at me with these pretty and gentle eyes and always tells me i'm important and worth while, that i need to fight this and that he's always there for me that i can call him if i want to just talk (him or his nurse).
ok, i need to stop...my hearts beating a little fast now ;^)
sorry for the book.
b2c.> For those who see a pdoc and a T, how does it work for you? Any conflict between the two? And what do you think about her attitude?
>
> Thanks,
>
> gg
Posted by DaisyM on August 4, 2004, at 10:49:31
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by lucy stone on August 4, 2004, at 10:24:43
I don't know GG, anyone who told me these things in such a blunt way would make me nervous. How does she REALLY know how you are doing in a 20 minutes conversation? It seems to me that she is hearing the side of you that feels bad about how things are going right now (you've had a tough couple of weeks) and she is going to "fix" you.
I could walk into any office right now and in 20 minutes have them convinced that I am perfectly fine...so would she tell me I don't need therapy at all?
I'm not saying don't work with her, I just don't want her to make you doubt yourself and get more depressed. I think she has already done the first. I can't imagine why she would feel it necessary to tell you you are acting like a child. She might think that and suggest working on a "more resilient way of coping with marital fights" but still...She was awful quick to judge.
I don't think your therapist will be upset with you. But he would probably question why you feel you need to work with this other person, beyond meds. Are you not getting what you need from him? Did she make you feel bad about certain things so you now feel you HAVE to work on them? Is there an underlying curiosity about her methods, or the fact that she is female?
Just me thinking out loud here. Somehow I'm reminded of your old boss whose CBT orientation you argued with a lot, and your therapist shares your views (I hope I didn't get that wrong.) If it was me, I don't think I'd have a session with her until my therapist was back and I talked to him about it. If he thought it was an experiment worth trying, then I would proceed. (OK, I wouldn't but that is just me.)
I should also caution that all of the above may be a bit strong because we've spent the last few sessions talking about how hard I try live up to my mother's expectations of me and how she would think the regression that therapy has brought on is ridiculous. She has always told me that I was too sensitive and moody, and that smart, strong women don't need therapy. They just need to plow through life and eventually everything gets better.
Your description of this doc hit a nerve.
Posted by Poet on August 4, 2004, at 10:52:53
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
Hi GG,
My pdoc has told me that he wants to do therapy with me. So far I'm just seeing him once a month for meds management. He's really into the psychodynamics of work and my basing my self esteem (or lack thereof) on career success has sparked his interest in me.
I see my T tomorrow morning and pdoc tomorrow afternoon. I'll ask my T if it's unusual to do therapy with two people. I'll let you know what she says.
Poet
Posted by pegasus on August 4, 2004, at 11:34:56
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
Well, my pdoc was recommended by my T, who lobbied long and hard to get me to even consider meds. Apparently they work together frequently (or used to, before he moved, the b*****d ;)). The thing is that my T can't prescribe meds, being a psychologist and not an MD. So he needs to work with someone on this type of thing. They spoke every now and then about how I was responding to meds (apparently very well). I found it helpful to see both.
BUT . . . frankly, I'm not interested in what my pdoc thinks about my problems or how I'm handling them. All I want from her is info and Rx for meds. My T and I are working out the rest. I see my pdoc rarely (maybe twice a year), and only when I think I might need a med change. When I'm fine on the current dose, I call her when my Rx runs out, and she calls the pharmacy with a refill. This is perfect for me.
Good luck figuring out what to do here. Can you put off deciding about the more therapy-related aspects of the pdocs treatment until your T gets back and you have a chance to talk about it?
pegasus
Posted by Dinah on August 4, 2004, at 11:43:08
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by pegasus on August 4, 2004, at 11:34:56
Oh, Pegasus, I'm glad you said that. My therapist thinks I should confide more in my pdoc, but if something doesn't have medication implications, I see no reason for him to hear about it.
I tell him about upcoming or past stressors, reactions to meds, problems that aren't being adequately addressed by meds. Anything else is none of his business. After having one pdoc who was too involved in my psyche, I resolved not to have that happen again.
My therapist thinks I'm being stubborn. My pdoc is clear that he doesn't *want* to hear about anything that doesn't affect my meds.
Posted by gardenergirl on August 4, 2004, at 19:12:49
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by lucy stone on August 4, 2004, at 10:24:43
Thanks for your thoughts. It occurs to me now that he may have been able to help with a referral to someone who might consider taking me as a professional courtesy. And I won't see her again until after he gets back, because the plan is to see her monthly. So I will have the opportunity to backpedal with her if my T and I think that's best.
And it does feel a bit like someone is messing with my head and my comfort with my therapy. I'm just such a "go-along-er" sometimes, that I don't speak up and think of disagreeing until later.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:17:15
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by B2chica on August 4, 2004, at 10:39:02
Hi sweetie, good to hear from you. It sounds like you have a good arrangement going on. That's great. I think what you describe is actually what I had in mind when I met with her. Somehow, I let her "putting the cards on the table" influence me beyond my normal way of approaching things. Because come to think of it, I even told her up front that I was interested in med management as I was quite happy with my T. Hmmm. I had a tiny feeling she was turning her nose up at his approach. Nothing she said overtly, but just a hint.
So glad your T passed test number 3. Sounds like my kind of T.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:27:40
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by DaisyM on August 4, 2004, at 10:49:31
> I don't know GG, anyone who told me these things in such a blunt way would make me nervous. How does she REALLY know how you are doing in a 20 minutes conversation? It seems to me that she is hearing the side of you that feels bad about how things are going right now (you've had a tough couple of weeks) and she is going to "fix" you.
To her credit, she did spend more than an hour with me. I was kind of tickled about that, because this is my first experience actually paying for mental health care. And it was pricey. Will apply to my deductible, but still. But I think you are right, she was taking a very problem-solving approach, which would fit better with CBT than psychodynamic. And I didn't try to hide my warts, well except for the one I haven't yet shown my T...So I probably did look pretty bad on paper.
> I'm not saying don't work with her, I just don't want her to make you doubt yourself and get more depressed. I think she has already done the first. I can't imagine why she would feel it necessary to tell you you are acting like a child. She might think that and suggest working on a "more resilient way of coping with marital fights" but still...She was awful quick to judge.Oh my goodness, I think you really hit on something here that I couldn't see. She DID make me doubt myself. I felt terrible about myself when I left. I even though, what's the point in upping my medication if it's just that I am an irresponsible, lazy bum? Although at one point, I did share with her that one of my big motivators was the avoidance of shame. So perhaps she felt the need to shame me? If so, ugh. We also talked briefly about tangible rewards or punishments, and we were talking major amounts of money. The thing that I could come up with that would be most aversive to me in order to motivate me was donating four figures to the Bush campaign. She jumped and said, "Let's not go that far!" So I do like that about her. :D
>
> I don't think your therapist will be upset with you. But he would probably question why you feel you need to work with this other person, beyond meds. Are you not getting what you need from him? Did she make you feel bad about certain things so you now feel you HAVE to work on them? Is there an underlying curiosity about her methods, or the fact that she is female?Well, I think he will admit that he can't give me this if I do indeed need it. But he doesn't think that's what I really need, or I would have figured it out for myself. And I think in some ways, he is right. But the transference thing is being triggered in that I am worried he will be disappointed in me. :(
>
> Just me thinking out loud here. Somehow I'm reminded of your old boss whose CBT orientation you argued with a lot, and your therapist shares your views (I hope I didn't get that wrong.) If it was me, I don't think I'd have a session with her until my therapist was back and I talked to him about it. If he thought it was an experiment worth trying, then I would proceed. (OK, I wouldn't but that is just me.)Yeah, I definitely am in the same camp as my T. I can't imagine ever saying something so blunt to a client. Not without a lot of warm and fuzzy and a solid relationship first.
> I should also caution that all of the above may be a bit strong because we've spent the last few sessions talking about how hard I try live up to my mother's expectations of me and how she would think the regression that therapy has brought on is ridiculous. She has always told me that I was too sensitive and moody, and that smart, strong women don't need therapy. They just need to plow through life and eventually everything gets better.
Oh, I hate that idea. There is still a little voice inside me that has this view, too. Not sure where I got it, except perhaps that I always had to be independent and solve problems myself if I wanted to be sure they were solved. Asking for and needing help still feels like weakness to me a lot of the time.
>
> Your description of this doc hit a nerve.
>
Sorry about the nerve. But your post really resonated with me. I think your take on it is right on the money. I'm glad that I don't see her again before I see my T. I feel a bit more confident about what I need and what I need to do.Thanks,
gg
Posted by gardenergirl on August 4, 2004, at 19:29:57
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by Poet on August 4, 2004, at 10:52:53
Thanks Poet. I'll be interested to hear the answer.
Take care,
gg
Posted by gardenergirl on August 4, 2004, at 19:31:40
In reply to Re: Good therapist-cop/Bad therapist-cop, posted by pegasus on August 4, 2004, at 11:34:56
You know, more and more, I think an arrangement like what you describe is what I need. It's what I wanted going in. Just got sidetracked somehow by the force of her personality.
Yeah, I will see my T before I see her again. Just obsessing right now. It's what I do. :)
Take care,
gg
Posted by mair on August 4, 2004, at 22:11:03
In reply to Re: Good therapist-cop/Bad therapist-cop » pegasus, posted by gardenergirl on August 4, 2004, at 19:31:40
Maybe I missed something but how did it come about that you agreed to therapy with this woman anyway?
I see a pdoc periodically for meds management. Since i see her so infrequently, she asks me a lot of questions which seem like they ought to be coming from a therapist, and it makes me a little uncomfortable. Although I guess part of her evaluation is to review whatever symptoms seem to be plaguing me at that moment.
I did the 2 therapist thing for awhile, really at the behest of therapist #1 (a male) who thought I might be more comfortable talking about some issues with therapist #2, a woman. They worked in the same office. I think therapist #1 was hoping therapist #2 could do some CBT with me, which really wasn't his forte at all.
After awhile it was confusing in the extreme, because what each of them did with me wasn't different enough. Also, at some point they had a falling out and I felt sort of pulled between the 2. I don't think I'd go down that road again. Unfortunately, the experience ended up souring me on both of them, so that rather than having 2 therapists, I ended up with none.
As for her attitude - try to imagine how one of your own clients would feel if you proceeded to sum her up in the first session. I think we all like to think that we're a little more complicated and multi-layered, and that neither our problems nor the solutions are so totally transparent.
Mair
Posted by gardenergirl on August 5, 2004, at 8:17:49
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by mair on August 4, 2004, at 22:11:03
Thanks for your input. I agree, if I had said something like that to a client I would not be establishing rapport. I think that I just got kind of sucked in by the force of her personality. And I suppose the "wish" that there is something I can do to get well quicker.
Sounds like your experience was, er a learning opportunity? :) Thanks for sharing it.
Take care,
gg
Posted by Poet on August 5, 2004, at 18:16:16
In reply to Re: Good therapist-cop/Bad therapist-cop » Poet, posted by gardenergirl on August 4, 2004, at 19:29:57
Hi GG,
My T said that if I want to start therapy with pdoc that I could still see her monthly or on as needed basis. She wanted to get into why I thought I wanted to see him more, but I told her that it's something that I'm just wondering about and not ready to do it.
Poet
Posted by antigua on August 5, 2004, at 18:57:07
In reply to Good therapist-cop/Bad therapist-cop, posted by gardenergirl on August 4, 2004, at 9:38:44
Well this is kind of funny. Overkill, maybe. I have a Pdoc and two therapists. My Pdoc is meds only (bi-monthly or monthly) but he likes to check in on how I'm doing. He focuses on my ability to function as well as possible in life--his goal is to make me feel GREAT, he says, and not just be surviving. I'll believe that when it happens.
T #2 is my EMDR therapist. Sometimes we just talk and don't do EMDR at all. She's o.k.; her view differs a little from other T, but I mostly use my time w/her to let EMDR open up my emotions.
T #1 leads all of the others. She is in total control. I defer to her because she knows me best. She always "reframes" what the others said, based on what she knows about me.
The other difference is that I'm only attached and emotionally invested w/T#1. I don't need any more complications in my life.
Actually, this is all working out quite well. Expensive, but it's going well.
antigua
Posted by gardenergirl on August 6, 2004, at 20:05:01
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by Poet on August 5, 2004, at 18:16:16
Thanks for passing this on. I bet I'll have to get into why I felt like agreeing (whether I stick with it or change my mind) with my T.
Take care,
gg
Posted by gardenergirl on August 6, 2004, at 20:06:20
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by antigua on August 5, 2004, at 18:57:07
Wow! I'm glad it's going well. The first thing I thought of when I read your post was "how does she keep everyone straight?" But I bet it's not that hard. And it also sounds like everyone understands their individual roles. And it certainly does sound expensive.
Thanks for sharing your experience.
Take care,
gg
Posted by gardenergirl on August 6, 2004, at 20:11:04
In reply to Re: Good therapist-cop/Bad therapist-cop » gardenergirl, posted by antigua on August 5, 2004, at 18:57:07
How can I tell her I changed my mind without looking like a total flake? And why do I care if I look like a flake to someone I just met? In some ways, I feel like there is instant transference going on...which feels odd. Am I just really into passivity or people-pleasing right now because I'm more depressed? Sigh, I wish my T were here....(Now why did I really want to type "I wish my brother George were here" and put up a candlabra on a grand piano?) :D
gg
Posted by Dinah on August 6, 2004, at 23:00:51
In reply to So, suppose I want to change my mind....., posted by gardenergirl on August 6, 2004, at 20:11:04
Your therapist is coming back before you see her again, right? Once you discuss what she said with him and get his reaction, you'll know better if there are any "rules" from your therapist and how he'll feel about it.
I'm always upfront with any adjunct therapist I see that my therapist doesn't allow dual therapy. If your therapist doesn't either that should solve your problem. On the other hand, biofeedback guy was real nasty about my therapist not allowing me to have two therapists at once. Of course, biofeedback guy was nasty about everything.
Posted by gardenergirl on August 7, 2004, at 0:21:38
In reply to Re: So, suppose I want to change my mind..... » gardenergirl, posted by Dinah on August 6, 2004, at 23:00:51
Thanks, I am looking forward, sort of, to talking with my T about this.
Do you suppose there is a biofeedback location for nastiness? Perhaps that T could use some work? :)
Take care,
gg
Posted by mair on August 8, 2004, at 15:51:48
In reply to Re: So, suppose I want to change my mind....., posted by gardenergirl on August 7, 2004, at 0:21:38
Didn't you just meet with this woman once? Also, I don't recall that you went into see her with the idea of having an adjunct therapist - I thought she's the one who raised it?
I don't think we should ever have to totally own decisions we make when we're put on the spot. Life is all about further reflections.
Mair
Posted by Joslynn on August 9, 2004, at 22:59:46
In reply to Re: Good therapist-cop/Bad therapist-cop » mair, posted by gardenergirl on August 5, 2004, at 8:17:49
Sorry I am late to this. Gardner Girl asked: "For those who see a pdoc and a T, how does it work for you? Any conflict between the two?"
Yes I see both a pdoc and T, and unlike some situations, my pdoc also does therapy with me. I see my T every other week for therapy and my pdoc once a month for med check & an hour therapy.
How it works: I talk to them about very similar things. Since I am single, and a lot of my situations involve the, er, challenges of dating, I like to have both the male and female perspective. My pdoc is a very kind person who is somewhat protective of me in the way he asks questions about someone I am dating. Sometimes, as a man, he will call a another "guy" on his behavior when that guy is not treating me well in a way that my female therp may miss. It's hard to explain.
You know how sometimes, your guy friends or brother will ask questions of whoever you are dating in a protective, big-brother kind of way? It's sort of like that.
My female therp, on the other hand, is great at making me realize the options I have and reminding me that I am a survivor and will continue to survive. She helps me stay out of catastrophizing and fantasizing. But sometimes, she misses little things about men in my life that the male pdoc picks up on. My therapist also has a more confrontational style (in a tough love way, which is good) whereas my pdoc is more reflective of how I feel.
As far as I know, they don't talk to each other about me (shocking that I am not a case of constant fascination to them!), but they both have each other's numbers. My pdoc told me to tell my therp that he wants her to call him if I seem to be "slipping," if that is ok with me, which it is. So far, I don't think she has made a call like that.
What is nice is, if my therp is on vacation, I can call my pdoc, and vice versa. I don't have many crises where I feel the need to call them, but the few times crises have occurred, they have always happened when one of them has been on vacation!
My pdoc saw me firsthand when I was in a very severe depression and he was by my side through the first weeks of that. So, I don't think I could just use him for meds and see my female therp just for therapy.
I feel that because he saw me at my worst and helped me through it, there was some sort of "imprinting" there, like the goslings do, and I still like to see him as well as my therapist. (I went to her a few weeks after the height--or rather, low?-- of the severe depression.)
Sometimes I will talk him about a comment or theory she had about something or I will talk to her about something he said, usually about meds or something like that.
I would not give either of them up and I think that both of them enhance, rather than detract, from each other.
That said, I think it was not nice or effective for your new pdoc to say you were acting like a child! Especially when she was just in the "intake" phase. How can she even know you well enough to even say those things? Plus, there are better ways to communicate!
But if she has tips for procrastination, do share!!!
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