Psychiatrist v Psychologist

silent1 · 22-01-2010 11:18pm #1

As a client of both of the above services, one public and the other private, is it a given that they are at odds with each other?

The Psychologist has indicated his disapproval at the Psychiatrist's reluctance to look a the underlying problems of the condition. The psychiatrist seems uninterested in the progress with the Psychologist.

There seems to be some resentment about medication v therapy, coming from both sides. I think a bit of both is best, but is this the norm?

nesf · 22-01-2010 11:26pm

I think the problems in these cases often occur when a psychiatrist and a psychologist aren't aware of each other and worry about one undermining the other's work. Personally I think the best bet is to, for instance, get recommendations of psychologists from your psychiatrist since it's better to work with two people used to working with each other who will be able to trust the other not to undermine the other's work.

silent1 · 22-01-2010 11:33pm

Thanks nesf.

The problem was, I attended the public Psychiatric service, they actually recommended that I get counselling. They have one Clinical Psychologist on their staff, but I could not get to see him because he was under pressure, of too many people too little time. So I was left to my own devices to find a counsellor - I saw a counsellor for a while - did not make much progress. Decided to see a qualified psychologist, expensive but well worth it - it was her that diagnosed my condition. As I am still on medication I need to also attend the Psychiatrist. Just feel torn between the two.

Odysseus · 23-01-2010 3:00pm

silent1 wrote: »

As a client of both of the above services, one public and the other private, is it a given that they are at odds with each other?

The Psychologist has indicated his disapproval at the Psychiatrist's reluctance to look a the underlying problems of the condition. The psychiatrist seems uninterested in the progress with the Psychologist.

There seems to be some resentment about medication v therapy, coming from both sides. I think a bit of both is best, but is this the norm?

Sadly these things happen, we get a new psych reg on our team every 6 months or a year. Our new guy has been referring long term clients of mine to other services, not always the case but alot of psychiatrists have limited knowledge of psychotherapy or psychological interventions, they are only aware of what the last paper they read stated.

Clearly you need the services of both, but it appears here you will just have to make the best of the situation, it sounds like your psychiatrist is interested in merely symptom reduction or management, and not the historistical component. So to answer your question, yes it can be the norm, but it cepends on the team, and sadly your psychologist is outside the team your psychiatrist is working in.

JuliusCaesar · 23-01-2010 10:54pm

Has your psychologist written to your psychiatrist? Has the psychologist phoned the psychiatrist? If not, ask him/her to do so. Writing is generally better as the letter has to go into your file.

Is your Psychiatrist a Registrar or a Consultant? If he/she is a Reg, you can ask to see the Consultant. If he/she is a Consultant, you can ask for a second opinion if you are not satisfied with the present psychiatric treatment.

Treatment will work much better if your treaters are all working together rather than in isolation.

sam34 · 23-01-2010 11:34pm

silent1 wrote: »

The Psychologist has indicated his disapproval at the Psychiatrist's reluctance to look a the underlying problems of the condition. The psychiatrist seems uninterested in the progress with the Psychologist.

There seems to be some resentment about medication v therapy, coming from both sides

Odysseus wrote: »

not always the case but alot of psychiatrists have limited knowledge of psychotherapy or psychological interventions, they are only aware of what the last paper they read stated.

it sounds like your psychiatrist is interested in merely symptom reduction or management, and not the historistical component.

JuliusCaesar wrote: »

Is your Psychiatrist a Registrar or a Consultant? If he/she is a Reg, you can ask to see the Consultant. If he/she is a Consultant, you can ask for a second opinion if you are not satisfied with the present psychiatric treatment

interesting, but not surprising, that though the OP acknowledges there is a resentment on both sides, the responses here jump to the conclusion that it is the big bad psychiatrist at fault, and not the psychologist, or both.

Odysseus · 24-01-2010 12:41am

sam34 wrote: »

interesting, but not surprising, that though the OP acknowledges there is a resentment on both sides, the responses here jump to the conclusion that it is the big bad psychiatrist at fault, and not the psychologist, or both.

Hi sam, I did say not always the case, as oppossed to saying it's alway the case. Though to be fair you do have a point. However, when typing it did bring to the fore some difficulties I having with a reg, who is refferring out clients that I have being seeing long-term. No disrespect to the CBT guys here, but the typical short term treatments he is referring to will be of no use to the guys I'm treating, long-term addicts with various long term difficulties.

I'm going off topic above, but most psych's I know are not that interested in underlying issues, they are focused on treatment and management, would you disagree? If it came across "big bad" psych that was not my intention.

I know some psych's with a vast knowledge and interest in psychotherapeutic interventions, but they are few and a far between in my service. Though yeah, I have to put my hands up, I did not acknowledge the "both sides" of the OP's post, but the above may explain the "underlying" causes of my post;)

sam34 · 24-01-2010 10:44am

Odysseus wrote: »

Hi sam, I did say not always the case, as oppossed to saying it's alway the case. Though to be fair you do have a point. However, when typing it did bring to the fore some difficulties I having with a reg, who is refferring out clients that I have being seeing long-term. No disrespect to the CBT guys here, but the typical short term treatments he is referring to will be of no use to the guys I'm treating, long-term addicts with various long term difficulties.

I'm going off topic above, but most psych's I know are not that interested in underlying issues, they are focused on treatment and management, would you disagree? If it came across "big bad" psych that was not my intention.

I know some psych's with a vast knowledge and interest in psychotherapeutic interventions, but they are few and a far between in my service. Though yeah, I have to put my hands up, I did not acknowledge the "both sides" of the OP's post, but the above may explain the "underlying" causes of my post;)

hi odysseus,

i know you did say "not always the case" and i included that in my quote, in the interest of fairness

i suppose my point is that psychiatrists are castigated far and wide for over-prescribing and not going down the psychotherapy route.

but people seem to forget that that's what we're trained and qualified to do - prescribe! thats what we bring to the MDT that nobody else does.

it seems crazy to criticise psychiatrists for "only" being interested in treatment/symptom reduction/management.

(in any event, how much knowledge does teh average psychotherapist have about psychopharmacology? does it extend to the "last paper they read"?)

i woudl imagine that most psychiatrists acknowledge the value of psychotherapeutic interventions. those who don't, quite frankly, are letting down their profession.

but the reality is that we in the public service very often dont ahve access to psychologists.

so what do we do? we have no option but to treat solely with meds. i know looking at patients sometimes that they would do better with a psychologist in combination, or at times that purely CBT would suffice, but what am I to do when the option isnt there for me?

i cant, in all consciousness, leave someone untreated. morally and ethically that would be wrong.

imagine if a cardiologist didnt prescribe anti-hypertensives, instead preferring to refer to a dietician, but the waiting list was so long that the patients were running into teh complications of untreated hypertension - MI, stroke, death... the cardiologist would be hung out to dry for not having prescribed.

yet us psychiatrists are damned if we do - we're throwing meds like smarties at people, and damned if we dont- blamed for the rising suicide rate etc

it would be foolish to think that we as psychiatrists hold all the answers and therefore dismiss everyone else, but there's no reason to think that psychiatrists and psychologists can't work together and complement each other.

interesting that you're having issues with a psych reg at the moment - i'm having probs with the psychologist at work! he has such a huge problem with psychiatry and psychiatric drugs,and he doesnt even try and hide it or disguise it behing some valid evidence based reason. there are continuous snide remarks about "the medics", "zombie-drugs" "pill-pushers" etc. he's pushing everybody quite far now, and doesnt ahve long to go before someone calls him up on it and possibly takes it further, as it is highly unprofessional.

anyway, this turned into quite a rant!

i hope im getting my point across clearly

JuliusCaesar · 24-01-2010 11:42am

sam34 wrote: »

i'm having probs with the psychologist at work! he has such a huge problem with psychiatry and psychiatric drugs,and he doesnt even try and hide it or disguise it behing some valid evidence based reason. there are continuous snide remarks about "the medics", "zombie-drugs" "pill-pushers" etc. he's pushing everybody quite far now, and doesnt ahve long to go before someone calls him up on it and possibly takes it further, as it is highly unprofessional.

I can only think the psychologist is newly qualified! Anyone who's been working in Mental Health for a while will see the value of medication. Often the meds are what enables us to engage in talking therapies...

It's important that every member of the MDT respects each others' input. We won't always agree, but the team should be able to work together for the good of the patient.

sam34 · 24-01-2010 11:48am

JuliusCaesar wrote: »

I can only think the psychologist is newly qualified! Anyone who's been working in Mental Health for a while will see the value of medication. Often the meds are what enables us to engage in talking therapies...

unfortunately, no. if he was new, i cound understand his attitude a bit, but he's been around quite a while.

meh, he's just one of these people who thinks he knows everything and that anyone who disagrees with him is wrong. they're in all walks of life.

he is behaving in a seriously unprofessional manner though, and my concern is what he is saying to patients about their meds unbeknownst to me.

Odysseus · 24-01-2010 12:11pm

sam34 wrote: »

hi odysseus,

i suppose my point is that psychiatrists are castigated far and wide for over-prescribing and not going down the psychotherapy route.

but people seem to forget that that's what we're trained and qualified to do - prescribe! thats what we bring to the MDT that nobody else does.

it seems crazy to criticise psychiatrists for "only" being interested in treatment/symptom reduction/management.

(in any event, how much knowledge does teh average psychotherapist have about psychopharmacology? does it extend to the "last paper they read"?)

i woudl imagine that most psychiatrists acknowledge the value of psychotherapeutic interventions. those who don't, quite frankly, are letting down their profession.

but the reality is that we in the public service very often dont ahve access to psychologists.

i cant, in all consciousness, leave someone untreated. morally and ethically that would be wrong.

yet us psychiatrists are damned if we do - we're throwing meds like smarties at people, and damned if we dont- blamed for the rising suicide rate etc

it would be foolish to think that we as psychiatrists hold all the answers and therefore dismiss everyone else, but there's no reason to think that psychiatrists and psychologists can't work together and complement each other.

interesting that you're having issues with a psych reg at the moment - i'm having probs with the psychologist at work! he has such a huge problem with psychiatry and psychiatric drugs,and he doesnt even try and hide it or disguise it behing some valid evidence based reason. there are continuous snide remarks about "the medics", "zombie-drugs" "pill-pushers" etc. he's pushing everybody quite far now, and doesnt ahve long to go before someone calls him up on it and possibly takes it further, as it is highly unprofessional.

anyway, this turned into quite a rant!

i hope im getting my point across clearly

Yes Sam you did, it didn't come across as a rant. I wasn't criticising the mamagement aspect, more of a case of that is what you guys do. In a outpatient setting you don't see the patient weekly and have limited time, so my understanding is that is where the focus is.

Around the prescribing issue that is why I want certain clients to see our psych, I found myself in a position where I was asking clients to see a psych and then they try to refer to a different therapist which will have a long waiting list, when they have a established therapeutic relationship with me, madness. Anyway that was my way of saying I have no issues with meds, I felt the client would do better on meds and therefore referred to the person who job it is, what I did not want was a undermining of a long term established therapeutic relationship. In one case it took six months for the person to agree to go, after being told to see a different therapist they won't go back.

I fully agree none of us have the answers, well speaking for myself I try to keep up to date around meds, but its not really my area. So point well taken. THB I'm finding mixed experiences around the acknowledgement of psychotherapeutic interventions, some valuing, so not, some giving lip service. However, that is the same in all professions.

I know some anti-psych stuff can come up here, but most of us acknowledge the value of the interventions you provide.

JuliusCaesar · 24-01-2010 12:58pm

Odysseus wrote: »

I was asking clients to see a psych and then they try to refer to a different therapist which will have a long waiting list, when they have a established therapeutic relationship with me, madness.

This is probably due to the 6 monthly rotation of Regs - they don't always get a good orientation to the area and what services are available. The thing that makes me tear my hair out - and the clients theirs - is that often they don't see the same Reg twice due to holidays/sick days/study days if they are attending OPD monthly. It does hinder communication, and tbh I'd often jsut go straight to the Consultant if I want to query something. I've been there years, as have the Consultants, and we have good working relationships.

nesf · 24-01-2010 2:07pm

JuliusCaesar wrote: »

Often the meds are what enables us to engage in talking therapies...

This is one thing that makes me curious. I've seen friends go from being unable to make progress with psychology to making great progress with it after going on meds. It's not a binary situation where psychology works or it doesn't based on day 1 experiences (i.e. pre-meds).

The thing is, if a psychologist mostly (or almost entirely) works with GP referrals rather than with referrals within or from a psych hospital or psych consultants they could be seeing the thin edge of the wedge in terms of severity and could be seeing a very biased sample of patients towards those for whom medication isn't a necessity. I find it hard to believe that any psychologist working with bipolar patients would believe that drugs aren't needed (or at least any one that had tried to work with non-medicated patients during an episode) but I don't find it hard to believe that someone working with patients with fairly mild depression could come to believe that drugs are unnecessary. I mean, how exactly can psychology work with a psychotic patient who is unmedicated? It's not like you'll be able to convince them that what they think isn't real, that's kind of what the condition precisely makes the person unable to do..

Odysseus · 24-01-2010 2:30pm

nesf wrote: »

This is one thing that makes me curious. I've seen friends go from being unable to make progress with psychology to making great progress with it after going on meds. It's not a binary situation where psychology works or it doesn't based on day 1 experiences (i.e. pre-meds).

The thing is, if a psychologist mostly (or almost entirely) works with GP referrals rather than with referrals within or from a psych hospital or psych consultants they could be seeing the thin edge of the wedge in terms of severity and could be seeing a very biased sample of patients towards those for whom medication isn't a necessity. I find it hard to believe that any psychologist working with bipolar patients would believe that drugs aren't needed (or at least any one that had tried to work with non-medicated patients during an episode) but I don't find it hard to believe that someone working with patients with fairly mild depression could come to believe that drugs are unnecessary. I mean, how exactly can psychology work with a psychotic patient who is unmedicated? It's not like you'll be able to convince them that what they think isn't real, that's kind of what the condition precisely makes the person unable to do..

Nesf I don't think anyone here who works in a clinical way would not see the need for a bi-polar patient to be on meds, the same can be said for other disorders. Therapy with psychotic patients is quite complicated with or without meds, sometime the don't take them all by themselves. I have made some progress with some people who won't take their meds, but it would be very difficult to discuss it here. You would need the same knowledge of a particular type of psychoanalysis that I still find difficult after 12 years of study, and I'm not trying to be funny in saying that. However, I would have perferred those people where on meds, and they where limited interventions over a period of months. It helped, it would have helped more if the person took their meds.

Now as to the meds facilitating a client in coming to us that could be any disorder where the meds reduce the anxiety levels in some cases, or lift the mood a bit, or stablise the person to the extent that they can benefit from a talking therapy. Does that answer your question a bit?

nesf · 24-01-2010 2:35pm

Odysseus wrote: »

Nesf I don't think anyone here who works in a clinical way would not see the need for a bi-polar patient to be on meds, the same can be said for other disorders. Therapy with psychotic patients is quite complicated with or without meds, sometime the don't take them all by themselves. I have made some progress with some people who won't take their meds, but it would be very difficult to discuss it here. You would need the same knowledge of a particular type of psychoanalysis that I still find difficult after 12 years of study, and I'm not trying to be funny in saying that. However, I would have perferred those people where on meds, and they where limited interventions over a period of months. It helped, it would have helped more if the person took their meds.

Now as to the meds facilitating a client in coming to us that could be any disorder where the meds reduce the anxiety levels in some cases, or lift the mood a bit, or stablise the person to the extent that they can benefit from a talking therapy. Does that answer your question a bit?

I'm more getting at that someone who mostly works with patients on the less severe side of mental illness could very easily generalise their experiences to mean that psych drugs are unnecessary. What I find hard to believe is that someone working with more ill patients could manage to do this without lying to themselves or deceiving themselves due to ideological beliefs.

Odysseus · 24-01-2010 2:55pm

nesf wrote: »

I'm more getting at that someone who mostly works with patients on the less severe side of mental illness could very easily generalise their experiences to mean that psych drugs are unnecessary. What I find hard to believe is that someone working with more ill patients could manage to do this without lying to themselves or deceiving themselves due to ideological beliefs.

No I see you point, take me I work in the addiction field, that's the main stay of my work. I trained as a psychoanalyst. My main area of interest is co-morbid disorders, addiction and whatever disorder you want to name.

Traditionally within the area of addiction this has been a difficult area, its slowly changing. Typical treatment was no drugs whatsoever, a belief held by many therapists, it was the addiction that caused the other disorder, they used to say it was the primary condition. So later on in a persons recovery they where advised not to take meds.

Sadly there are still people out there who would work on the less severe side as you said and hold that opinion, but yes there would be people who would hold the second position. Thankfully not that many, I'm sure your aware of the whole anti-psych movement, so people still hold on to that. I'm avoiding going out for my run by posting here, I have a difficult marathon next month so I have to run now. However, I'll post a few refs latter around that if you want, but you seem to have studied the area quite strongly yourself so maybe they are not needed.

I end on this I often state here that I will only refer to another therapist at masters level, this is because I come accross lots of people who force sh!t about meds on their clients. Having a MA does not mean that won't happen, and there are great therapists out there with less study. However, the longer the study hopefully the less likely to hold false beliefs like the ones you metioned.

nesf · 24-01-2010 3:10pm

Odysseus wrote: »

No I see you point, take me I work in the addiction field, that's the main stay of my work. I trained as a psychoanalyst. My main area of interest is co-morbid disorders, addiction and whatever disorder you want to name.

Traditionally within the area of addiction this has been a difficult area, its slowly changing. Typical treatment was no drugs whatsoever, a belief held by many therapists, it was the addiction that caused the other disorder, they used to say it was the primary condition. So later on in a persons recovery they where advised not to take meds.

Indeed. Looking at my own family there's a long history of alcohol abuse with some co-morbid drug abuse on top of it. There have also been multiple bipolar/depression diagnoses in the ones who didn't become alcoholics. Bipolar is notorious for resulting in alcohol/drug dependence, I know I drank extremely heavily before going on meds. Could all those chronic alcoholics who had extreme difficulty getting off the drink have really had some underlying depression or bipolar condition that was fueling the self-destructive behaviour? Was it really self-medication? And so on.

It's a wonderfully complex and interesting question. I don't doubt for a second that it's not as simple as "they've undiagnosed bipolar" or whatever but it's fascinating to look at and think about.

Odysseus wrote: »

Sadly there are still people out there who would work on the less severe side as you said and hold that opinion, but yes there would be people who would hold the second position. Thankfully not that many, I'm sure your aware of the whole anti-psych movement, so people still hold on to that. I'm avoiding going out for my run by posting here, I have a difficult marathon next month so I have to run now. However, I'll post a few refs latter around that if you want, but you seem to have studied the area quite strongly yourself so maybe they are not needed.

I end on this I often state here that I will only refer to another therapist at masters level, this is because I come accross lots of people who force sh!t about meds on their clients. Having a MA does not mean that won't happen, and there are great therapists out there with less study. However, the longer the study hopefully the less likely to hold false beliefs like the ones you metioned.

Ignore the anti-psych movement, they shouldn't be part of any scientific discussion of the issue, it's a purely ideological position to be blunt about it. The problem I've referred to above could be turn on its head. A psychiatrist who has only worked with very severe cases could generalise that out to say that all psychiatric patients require meds. Most of the "best" psychiatrists I've seen don't believe this but I could see how some could begin to believe this purely because humans are extremely vulnerable to this problem, be it in medicine or any other area of life, we see a pattern and generalise it out to cover all possible cases regardless of the problems involved in such inductive logic.

Odysseus · 24-01-2010 7:51pm

Interestingly Nesf, I only seem two bi-polar clients last year. We don't get many of them in my service; that doesn't take away anything from your point though. We get a good few with various psychoses, and I'm not saying there aren't people who are addicted to heroin and have a psychotic disorder, we have quite a few.

However, something I have noticed over the years is that a lot of psychotic clients tend to go for the very drugs that will really mess them up. Cannabis, E, various hallucinogenic type drugs or amphetamines, really the stuff they should be avoiding. I have a few thoughts on it but no answers.

Personally I wouldn't ignore the anti-psych movement, well some of it. I hope I made my position about psychiatry clear here, however, I think some authors raise interesting questions, I may not concur with their answers, but that a different matter. I do a small bit of teaching on a few courses from diploma to masters level and I would bring some of that to what I teach. I think the students should be aware of it, as they will face it, and I would like to think that it facilitates them as becoming good therapists.

The generalisation thing is the worst thing in my opinion, I'm only stating the way I work and I'm not saying that is the only way to work. I think the regulars here know I respect how other modalities work, but the significant thing for me when I start seeing someone is that I know nothing about them, and that whatever their issue is, that it is subjective. I may know such and such about a particular disorder, but not about the person in front of me and their disorder if you get my point. Other people work differently and treat people effectively, so there is no one treatment.

Anyway I have probably gone to far off topic and will stop waffling now.

nesf · 24-01-2010 8:16pm

Odysseus wrote: »

Interestingly Nesf, I only seem two bi-polar clients last year. We don't get many of them in my service; that doesn't take away anything from your point though. We get a good few with various psychoses, and I'm not saying there aren't people who are addicted to heroin and have a psychotic disorder, we have quite a few.

My point about bipolar was that with bipolar patients alcoholism/drug addiction is very common, not that in alcoholism/drug addiction cases that bipolar was very common. Again, this is one of those logical **** ups where people think if you say many A's are B's then that implies that many B's are A's when it does nothing of the sort!*

Anyway, yes this has gotten terribly off-topic though hopefully it's interesting to the OP.

*Specifically: (because I feel it's important to be absolutely clear here) The truth of the statement "Most A's are B's" tells us nothing about the truth of the statement "Most B's are A's." It may be true that many bipolar sufferers have a family history of alcoholism, this tells us nothing about the truth status of the statement "Many alcoholics have a family history of bipolar disorder". The latter may or may not be true, the former doesn't tell us whether it is or not. This is one of the most common human logical errors (i.e. errors that crop up a lot when people are thinking). If you look out for it it crops up constantly in mainstream media.

Psychiatrist v Psychologist

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