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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Racer on December 16, 2004, at 20:02:27
This just came up, and I'm not sure how to deal with it. I'm seeing a Registered Dietitian for Nutritional Counseling as well as my dear SparklingBright for talk therapy, and The Good Dr CattleProd for meds. The RD just suggested -- very strongly, in fact -- that I start seeing a T who specializes in eating disorders, either as well as or instead of SparklingBright. I understand why -- I'm not progressing very well so far, and had lost weight at my last appointment -- and I actually think it might be a good idea for a couple of reasons, but I also feel afraid. Afraid of a lot of things, making a mistake by doing it, hurting SparklingBright's feelings, diluting therapy by seeing two Ts for different things that overlap so much, etc.
To be very honest, I think I'm also afraid that I'd recover from the anorexia if I see a specialist, but that's something to work on in therapy, ain't it?
Anyway, I wonder if anyone has anything to offer on this topic? Has anyone seen a specialist as well as a generalist? How did it go? What would you do if you were faced with a situation like this?
Thanks, in advance, for sharing insights.
Posted by underthecs on December 16, 2004, at 21:02:38
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
I have added a specialist for my addiction issues. It was a little strange at first, but they are both so different in personality and approach that now I feel like I have a good match... a good "team" working on me. But the extra "reinforcement" that I brought in is only temporary...until I get this part of my life under better control. Then I will just see my regular therapist. Hope this helps.
Posted by daisym on December 17, 2004, at 0:44:40
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
I haven't done this personally. I've got sort of run-of-the-mill issues. However, in my work, we do this all the time. A generalist works with kids and we add in whatever else is needed - speech, OT, etc. It works really well because the generalist provides a lot of support and keeps an eye on everything, not just the one big issue. But the big issue is being worked on in a concentrated way.
I shouldn't have to remind you that it isn't your responsibility to not hurt your therapist's feelings. But it speaks to your positive feelings about her and that is good! I think you should ask her how she would feel about you working with a team. She may not view this as diluting (OK, originally I typed deluding, lol) your therapy at all. And by telling her about this idea, you could also bring up you might be afraid to get better. This sounds really important.
Nice to see you posting here, btw!
Daisy
Posted by dawnfawn on December 17, 2004, at 6:30:18
In reply to Re: Seeing a specialist as well as my T? Anyone?, posted by daisym on December 17, 2004, at 0:44:40
I am not picking on anyone I have been reading about multiple treatments on this web site.
I feel I have fallen through the rabbit hole. A Talk therapist, A drug therapist, a special therapist. Number one how do any of you find time for your lives--work, school, family. Number two how do you pay for this. Number three what is going on here are all these doctors inadequate? Is everyone scared to make a diagnosis in this age of specialization. Help me out here.
Posted by underthecs on December 17, 2004, at 7:59:05
In reply to Re: Seeing a specialist as well as my T? Anyone?, posted by dawnfawn on December 17, 2004, at 6:30:18
To answer your questions, dawn:
Actually, I didn't have much of a life while I was drinking and using. So, now that I'm sober, one extra hour per week of therapy keeps me that way... which actually gives me back several hours of time that was usually spent fubared... And, his fee is very discounted, to answer your question about how one affords therapy. If it keeps me from driving drunk and killing myself or someone else, I think I can take one extra hour per week to help myself.
As to my primary therapist being inadequate, well I find your comment offensive. Only a therapist with ethics and confidence in himself can say, "I do not have what it takes to be confrontational enough to deal with acute and active addictions." So, I get that elsewhere...with an LCDC who is specifically trained in this area. Which still leaves me with my supportive and highly trained (just not highly confrontational) therapist for my longer-term issues. I still have the safety of that relationship to process what goes on with the LCDC.
Posted by dawnfawn on December 17, 2004, at 8:04:05
In reply to Re: Seeing a specialist as well as my T? Anyone? » dawnfawn, posted by underthecs on December 17, 2004, at 7:59:05
I am sorry if you find my comment offensive. No offense is ever intended, emails and postings are difficult to write as inflections of voice and eye contact are missing. Of course the offense would have to be taken by the therapist not you you are the patient, client, etc. I hope you find what you are looking for. You are certainly brave. Once again my apologies.
Posted by gardenergirl on December 17, 2004, at 8:58:56
In reply to Re: Seeing a specialist as well as my T? Anyone?, posted by daisym on December 17, 2004, at 0:44:40
>
She may not view this as diluting (OK, originally I typed deluding, lol) your therapy at all.Thanks for the chuckle, Daisy!
gg
Posted by gardenergirl on December 17, 2004, at 9:05:15
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
Hey lady,
I don't have experience in this other than in working as part of a rehab team. Multidiscplinary work is often quite effective, although the team members need to be able to work together and not in opposition.In working with my T and my pdoc, occasionally I hear things from my T when he disagrees with my pdoc that are kind of odd. I get this odd feeling that there is a competition going on. I really see my pdoc for medication management and for general educational stuff. I do tell her some of the issues I am working on, and she offers her insights, but it's more from a psychoeducational approach than a working therapy thing. So I am quite comfortable in the two roles they play.
I also think that you are quite insightful about the potential obstacles you might put in front of yourself in considering this. You know what they are, and I think that will be helpful in countering them should you decide to try this.
And for what it's worth, I think it's an excellent idea!
btw, I'll be sending you that stuff I promised today. Hope you find it helpful.
gg
Posted by Racer on December 17, 2004, at 10:03:13
In reply to Re: Seeing a specialist as well as my T? Anyone?, posted by dawnfawn on December 17, 2004, at 6:30:18
Just for a quick and dirty explanation of why most people would have more than one professional on a treatment team:
The psychiatrist is a medical doctor, and these days is generally a psychopharmacologist -- someone who prescribes medications, but doesn't do therapy. There are exceptions, of course, but there's also the expense and the issue of what insurance will pay for. Besides, psychiatrists are trained as physicians, which a specialty. They're not trained as "therapists" per se.
The therapist can be a Psychologist, Marriage and Family Therapist, Licensed Clinical Social Worker, etc. Lots of different levels and licenses, but they all come back to being trained and licensed to do talk therapy. They can't prescribe medications, can't admit a patient to a hospital directly, etc. They can do talk therapy. That's why we see them, for talk therapy. Medications alone cannot fix what ails us, so we also talk to someone to learn healthier coping strategies.
Then there are some situations that might require more intensive treatment. I don't think I need to be hospitalized for refeeding and treatment, and I know my insurance wouldn't cover adequate care in hospital, but I need more than either my psychiatrist (Dr CattleProd), my therapist, or my Primary Care Physician can or will provide. Therefore, my treatment team also includes a Registered Dietitian for nutritional counseling and rehabilitation. That's on the borderline of mental health treatment, by the way, since it's also direct medical treatment. After all, while anorexia starves the brain and effects psychological functioning, it also starves the body -- aside from just being underweight, I also have bone loss and cardiac problems and so on. The RD can be seen as either psychological counseling or medical support. Take your pick.
As for seeing a specialist in EDs, as well as my T, that's more complicated. I do know that I need more than my current T is providing, and maybe an ED specialist will be better able to treat those issues, just by virtue of experience with them.
Hope that explanation satisfies.
Posted by antigua on December 17, 2004, at 12:02:20
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
I've had mixed results w/this and ended up putting myself in a bad place. Definitely my issue,not theirs. I have a T, Pdoc and had an EMDR T for the csa. The Pdoc actually does therapy w/me too, but I only see him monthly or so and we usually end up talking about different things, but it does get confusing. He was recommended by my T, but she doesn't always agree w/him. The EMDR T was recommended by my T too, but I would often spend too much time explaining to my regular T what happened w/my EMDR T (more and more of my session, really).
But what really happened was that I got myself into trouble, all mixed up and fell apart. I was always analytical and not emotional w/my T; I had the emotions w/the EMDR but I didn't feel safe enough to let them out; and my Pdoc sometimes confused me. My feelings were misplaced everywhere and I began (and still do) to have trust issues w/my regular T. I don't think this is transference this time and I feel very alone.
I've put my EDMR on hold until I can sort this out. I can't handle all three of them; I can't balance or reconcile the three of them or their views.
So, it hasn't worked well for me--but don't let that stop you!
antigua
Posted by Aphrodite on December 17, 2004, at 17:24:23
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
Racer, I have no experience with this, but I just have to say that my gut reaction would be the more the merrier. :) Seriously, when there are serious physical issues involved, a team of specialists seems warranted. That's why they have surgical teams, right? Anyway, I guess the only snag could be if you're getting conflicting advice. Maybe SparklingBright (love that, btw!!!) could help manage the team with you?
Posted by fallsfall on December 18, 2004, at 14:35:52
In reply to Seeing a specialist as well as my T? Anyone?, posted by Racer on December 16, 2004, at 20:02:27
At various points I have seen more than one professional. I've been seeing a therapist continuously (well, first one and then another...). I see a pdoc for meds. I have been in 2 "process" therapy groups. I have done DBT skills training. But none of those seemed to be unusual.
Recently, though, I took my 16 year old daughter to a therapist (she was tardy for school so much that she lost credit for an English class...). He decided that seeing just her wasn't going to accomplish anything, so he wanted to see the two of us together. My therapist thought this was fine, and seemed glad to have the help with the "daughter" issues. It seemed like some of what came out of this therapy was for her ("you don't have to protect your mother", "you do have to be reasonable")and some was for me ("set rules/consequences and enforce them"). But my daughter didn't like to go, and started refusing - and I went without her, because I still needed to know how to deal with her. My therapist was still encouraging this - he could see that I was getting stuff out of the therapy, and the therapy was also clarifying other issues that I would work on with him. But there came a time when my daughter's therapist was talking about helping me to adjust to her getting ready to leave home, and my therapist expressed some concern. He didn't want her therapist working with me on that level. As long as it was "How can I get her to school on time" and "How can I get her to pick up her messes", we were fine. So I stopped seeing her therapist (though the option is always there if she gets ridiculous again to bring her back).
I guess the question I would have for you is would the *nature* of ED therapy be different from your regular therapy? Or would there end up being a lot of overlap. (You have both a doctor and a dentist - they both take care of your help, but there isn't a lot of overlap). If there is a lot of overlap, then you might need to choose one or the other.
> but I also feel afraid. Afraid of a lot of things, making a mistake by doing it
*** It would only be a mistake if it didn't help as much as what you are doing now. And I would think that you should have the option of going back to what you have now, even if you did try something else.
> hurting SparklingBright's feelings,
*** This is SparklingBright's problem, not yours. I would think that if you said "Dietitian suggested that I might consider an ED specialist since things don't seem to be going too well. What do you think about that? Would an ED specialist help me? Do you think I need more help than you can give me? Would I see both of you, or would I need to take a break from you? If I needed to stop seeing you to see ED specialist, could I come back to you later?" This would say to SparklingBright that you have a decision to make (based on advice from a professional), and you would like his advice on this decision.
>diluting therapy by seeing two Ts for different things that overlap so much, etc.
>
*** See above> To be very honest, I think I'm also afraid that I'd recover from the anorexia if I see a specialist, but that's something to work on in therapy, ain't it?
*** This is such a hard thing. Being afraid to be better. I've been working on this in therapy for the last couple of months. We have made some progress, but there is still a long way to go. Have you talked to SparklingBright about this?
*** These are difficult questions. Talking about it seems valuable to me.
This is the end of the thread.
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