Posted by medlib on January 31, 2002, at 6:27:03
In reply to Choosing a Therapist or Pdoc, posted by mair on January 30, 2002, at 13:19:29
Hi Mair--
You might consider treating your friend as you would a client. Then, like any professional service provider, what you advise will be the best "fit" for the client and the problem. In my area we call this inquiry the "reference interview." (Our general rule of thumb is that what an individual asks for is almost *never* what they really want.)
On topics (or with people) too sensitive for direct questions, alternatives may be offered; the client then chooses which option is the best fit for them. For example, "It's best to choose a pdoc first for severe mood fluctuations, for depressions which have lasted more than 6 months, for those which seem unrelated to external circumstances, for those which are severe enough to seriously impair basic living (holding a job, personal care, severe sleep changes, etc.), for serious depressions which have recurred, or for those accompanied by suicidal thoughts or self-harm. These situations may require medication before therapy can be successful. Selecting a therapist first may be more appropriate when specific phobias or anxieties are the main concern, when depressions are connected to life events, or when patterns of behavior are dysfunctional." [my opinions]
Choosing a pdoc: personal recommendations help, but I'm assuming that that's not an option here. If reimbursement is a major issue, start with the insurer's list. Then decide how involved you want to be with the specifics of your treatment, since a pdoc must be willing to be more collaborative than directive with more involved pt.s.) They should be board certified in psychiatry and have expertise in psychopharmacology. (Ask if their practice includes many treatment-resistant patients--since those are more likely to require current awareness of a wider range of meds.) Other quality Qs: How do they keep current w. new meds? Affiliation w. local med school? (ex- My pdoc's part of the STAR-D research trials.) How handle btw.-visit problems or emergencies?
Personally, I require a pdoc whose expertise I can respect who will give me what I ask for or offer convincing reasons why not. I found him thru a friend's rec., but kept him because he fit my needs.Choosing a therapist: Have had several in the past, but can't afford one at present. If I could, I'd want to know: What are Th's clinical interests? Does he specialize? If so, for how long? What type of pt.s make up his practice? Professional affiliations? What treatment methods does he use most? What would be his therapeutic approach to X type of problem? And most important, of course, gut feel re potential for rapport/ mutual respect.
Hope your friend lucks out; unfortunately, there seem to be very few good ones out there.
Well wishes---medlib
poster:medlib
thread:17539
URL: http://www.dr-bob.org/babble/social/20020125/msgs/17593.html