Unusual response from psychiatrist?

[Locut0s]

So I told my psychiatrist about the issues I've been having recently regarding intense anxiety at night and my cravings for alcohol. I said I thought it had to do with the medication I was on and said that I think I should go off it or switch to something else. He refused to answer me though really. He said "what would you do if I told you you should stay on it?" I said I probably would stay on it, then he said "what would you do if I told you you should quit" I said I would probably quit. I said that most people would listen to their DR. Then he said "what would you do if I told you to get a job or go to school", these are of course my central issues. Basically he's saying I guess that I don't make my own decisions and leave all my choices to others to make even if I know the right choice. I know he's right about that. But he never told me what I should do regarding the medication. He said it seems I want to be medicated or in a fog so I don't have to face things. This is also true to an extent, certainly that's why I drink. But the meds were also prescribed by my previous psych. I'm going to go off it I think since it doesn't seem to be helping. Seems like an odd situation...

He's a psychoanalyst, Freudian type, and it seems he doesn't believe in meds. I suppose meds haven't done much for me. It's odd that he left the decision entirely up to me though. Didn't even say anything about how to quit etc...

[HereSince1628]

1. Don't go cold turkey with an SSRI without talking to a professional...

It can cause some difficult side-effects.

It's all dose dependent so you need expert advice from someone who knows your dosage etc

[Locut0s]

3. Yeah I know how to taper off it...

I've gone off Paxil before and tapperex without much trouble. But you would think he would tell me this since he has no idea I know this. Seems he doesn't even know much about meds, I could be wrong.

[polly7]

2. I'm really sorry Locut0s,

it sounds like you're going through a tough time.

Did he advise you about tapering off your meds if you choose to quit them? Depending upon what you're on ... suddenly stopping could be dangerous. I would talk to him again before quitting CT.

I think that sometimes psychiatrists are able to spend so little time with pts. that they're actually at a loss what to do or say when told medication isn't helping. I wonder if it might be helpful to see someone else who will go through your med Hx and work with you to try something different? I know meds aren't the answer for everyone, but many people try up to a dozen times or more before finding the right combination.

Just don't give up

[Locut0s]

4. Thanks Polly, actually my sessions with him are an hour long...

One hour a week. But he let's me do ALL the talking and just interjects here and there with advise on what he thinks may be at issue. If I ask him a question I usually just get another question back in response. He doesn't seem to believe in meds, but maybe that's just for me?

[polly7]

5. Oh ... well that's frustrating.

He should make himself clear with regard to the meds. It's unfair that you should have to decide what to do about them. The doctor I saw after I lost my dad was very specific with what I should expect from them, how long 'we' were going to try one or the other, and what the plan would be if they didn't work.

[get the red out]

6. I agree with this

The first psychiatrist I ever saw, the only one in the town I grew up in, was exactly like this to the extreme; except she did put me on meds, she just never seemed to care that they didn't work.

I was a teenager trying to describe what I now know of as OCD. She never told me anything, just question after question about my obsessions. As far as I knew, my fears I obsessed over were TRUE, I never got any kind of feedback on a diagnosis or what my symptoms were. I was just put on some kind of tricyclic antidepressant and when that did nothing, more questions. I went to hell off and on and finally REALLY to hell over the next 10 years. Maybe she helped someone, but she was no help for me.

[HereSince1628]

7. Maybe not.

A while back I visited a website on psychodynamic therapy.

One of the things that I saw there was a statement that the therapy involves challenging patient/client about issues in order to build a therapeutic relationship.

My own experience is that things can go very wrong when patient/client is challenged -outside- a trusting therapeutic relationship...

Maybe this is consistent with the guy's training. Psychiatrists are not rocket scientists, they are not high priests. If you don't understand why he did what he did. Or if you think he doesn't understand how what he did made you feel...TAKE IT TO HIM.

Only he knows what he was doing. It could have been something incredibly insightful...it could have been something unsufferably clumsy.

Asking him is the only way to get his perspective... if you care about what his perspective was.

[Tobin S.]

8. I agree, HS.

TAKE IT TO HIM!

[HereSince1628]

9. Things therapists are unlikely to tell you

1) He/she honestly doesn’t know whether they can help you or not, and that doesn't matter.
2) He/she isn't your friend and isn't going to be, but expects your intimate sharing of information.
3) If you ask to see the charted notes about your progress, you'll probably get a hard time about it.
4) They aren't supposed to give you advice, but they probably will.
5) Therapy is probably going to be emotionally painful at times, but you probably won't be warned about that because they haven't any clue about your triggers until they are tripped.
6) They don't think their graduate degree, grades, thesis topics, or anything about their training matters. At all.
7) If you're prescribed something other than a generic drug, there is probably a pharmaceutical company marketing program involved.
8) You may make a co-payment, but someone else pays the bill, sometimes reluctantly.
9) For billing purposes, they will give you a diagnosis whether you need one or not.
10) They like the status of their job, but they suspect they are disrespected, they dislike the constraints of office protocols, and are often frustrated with client’s inability to respond to their better than average talents.

[mecherosegarden]

10. A psychiatrist is not necessarily a psychoanalyst

Those are two different degrees. If your doctor is a psychoanalyst, "a Freudian type" then letting you do the talking is mostly what they do. This type of therapy is known as the "Talking therapy," where the clients are the one doing the talking and the therapist would be offering an empathetic and nonjudgmental environment. Part of that theorethical orientation is that the client should say " whatever comes to mind." It is a different approach than cognitive therapy , behavioral, humanistic, etc. Psychiatrist on the other hand, mostly prescribe medication and don't do much of the "therapy" part. For medication protocol, one should follow the psychiatrist's recommendations.

[Locut0s]

11. Actually this guy is both...

He's a registered psychiatrist. I checked the degree hanging in his waiting room But he also has accreditation as a psychoanalyst. He chooses, it seems, to operate mostly as a psychoanalyst. But on the books he's a psychiatrist. I suspect one of the reasons he chose to do this may be that here in Canada if you practice as a psychiatrist you fall under the universal health coverage plans of all provinces. While psychologists are not so covered in most provinces. If you want to be a practicing psychologist you have to set up your own practice and charge privately. One of the failings of our health coverage IMO.