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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by btrout on November 30, 2012, at 22:21:35
I saw a new therapist today and she required me to sign a release to talk to my psychiatrist in order to continue with therapy. She was kind of strange for other reasons, but I was going to give her a chance until I found this out. She insisted that compelling new patients to sign a release for this sort of coordination represents the Standard of Care. In fact, her patients experienced this as "empowering."
My illness is very much under control medically and I was seeking to explore some childhood issues with her. I find this approach anything but empowering and very much intrusive. I think her approach implies that I can't be trusted to be truthful and forthcoming with my information, before she even knows me. At the same time, she's saying that I should formalize my trust in her before I even know her.
I left feeling really strange after I said that I wouldn't be continuing with her.
Is this The Standard of Care? Is this just something she made up to coerce patients to sign, in order to cover her a** legally, somehow? It seems almost controlling to me.
What say ye?
Posted by Willful on December 1, 2012, at 10:48:31
In reply to Do therapists and pyschiatrists have to talk?, posted by btrout on November 30, 2012, at 22:21:35
hi btrout,
My reaction is that if you felt it was controlling, and it caused you to want not to see her, as opposed to continuing, that you should trust your gut.
I've never signed a form like that, nor have I heard anything about a standard of care-- except perhaps when there are medical procedures where there are specific guidelines, that should be met. Not in psychotherapy.
It could be that you have issues about feeling controlled, but nevertheless, there may have been things about the way she did it-- requiring it, being overly insistent about it, that you sensed. Those may make her a bad fit-- and you don't want to waste time over power struggles that start so quickly with a T.
Is there something that makes you doubt your judgment about not seeing her? Or something that especially recommends her?
The question of fit is so important in psychotherapy-- unless you don't want to look further, I would give her another appointment, if you inclined to, to test out your reaction. Or I would simply look further. There's no requirement that you like a therapist just because you've seen her once or twice. Your choice at this state could make a big difference down the line-- so it makes sense to be cautious.
Posted by btrout on December 1, 2012, at 20:04:53
In reply to Re: Do therapists and pyschiatrists have to talk?, posted by Willful on December 1, 2012, at 10:48:31
Thanks for the reply. I don't feel conflicted about not seeing her again. I have a history of medically mysterious illness where I was was seen by and written off by physicians as crazy because they did not know what was wrong and did not want to admit that they were stumped. My supposed craziness got put into my medical record and new physicians saw that and "managed" me rather than trying to help. (I am now recovered)
So, yes, afraid of suffering consequences from those who don't care as much as they might, who are just following procedure.
My initial question was because I would consider not telling a therapist about a psychiatrist if it is the usual thing to compel such a release.
> hi btrout,
>
> My reaction is that if you felt it was controlling, and it caused you to want not to see her, as opposed to continuing, that you should trust your gut.
>
> I've never signed a form like that, nor have I heard anything about a standard of care-- except perhaps when there are medical procedures where there are specific guidelines, that should be met. Not in psychotherapy.
>
> It could be that you have issues about feeling controlled, but nevertheless, there may have been things about the way she did it-- requiring it, being overly insistent about it, that you sensed. Those may make her a bad fit-- and you don't want to waste time over power struggles that start so quickly with a T.
>
> Is there something that makes you doubt your judgment about not seeing her? Or something that especially recommends her?
>
> The question of fit is so important in psychotherapy-- unless you don't want to look further, I would give her another appointment, if you inclined to, to test out your reaction. Or I would simply look further. There's no requirement that you like a therapist just because you've seen her once or twice. Your choice at this state could make a big difference down the line-- so it makes sense to be cautious.
>
>
Posted by mmealltalk on December 25, 2012, at 16:40:09
In reply to Do therapists and pyschiatrists have to talk?, posted by btrout on November 30, 2012, at 22:21:35
Hello, just my 2 cents-
As someone who HATES when people talk about me, i can totally understand you not wanting to commit right off the bat that they have communication etc. However, in terms of reality and ethics etc, it a different story. I do believe that there are therapists who make it a given that they be allowed to speak to psymds w/o permission whenever to keep a working alliance between what should be a treatment team. It doesnt mean the t thinks you would lie about psymd, but that they are on the same page. There is also the issue of what if your mental state is at a point that the t wants to speak to md and a release hasnt been signed in advance. They could be covering their butts, or have your best interest in mind. I agree that your instincts are what you should follow though. I have major control issues, I used to tell my T that if she wanted to talk to my psymd i wanted to know first, i wanted to know what was said, i wanted all the info that second, to a point that my T actually called my psymd on speaker once while we were in session. In retrospect, my T deserves alot more credit than that and though eventually I lost the option of open communication, I don't think its the end of the world. I have a different view of it now, not that my current psymd talks to my T, I don't recall the last time it came up, but, it probably was a standard thing. Anyway, just telling you my thoughts.
Mel
Posted by baseball55 on December 26, 2012, at 19:43:33
In reply to Re: Do therapists and pyschiatrists have to talk?, posted by mmealltalk on December 25, 2012, at 16:40:09
It's funny how differently we all react. I did therapy with my p-doc for a few years, when, at his urging, I started to see a DBT therapist. She had me sign a form to talk to him, which seemed very natural to me, since he was both my primary therapist and prescribed meds. When I went through this month-long anxiety attack, for which he would not prescribe benzos because of my prior issues with addiction, she called him and convinced him to prescribe a benzo. He has never given me any form to sign, yet he calls her every couple of months to check in and see how she feels I am doing. I never gave permission for this. He just does it. When I was suicidal, he called my husband more than once without my permission. It never has bothered me. I feel good that they all care enough about me to keep in touch. Grateful even.
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