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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by antennastoheaven on June 6, 2013, at 3:48:43
So at my most recent therapy visit my therapist recommended that I consider a partial hospitalization program. My depression has been worsening over the past month or so, and for the few weeks I've been on Emsam. It hasn't been going so well: http://www.dr-bob.org/babble/20130527/msgs/1044478.html
Before quitting Wellbutrin and stopping Emsam I wasn't doing too bad. I was unhappy, and not particularly enjoying life, but I was at least able to show up at work and be relatively productive. This is important to me. Since then anhedonia has gotten worse and motivation has dropped a lot, and I haven't been going to work for the past four days and won't be going in tomorrow. I need to get medical leave paperwork soon, and according to my therapist I need to enter a treatment program for that to happen (not sure if this is actually necessary under California short term disability, but sitting at home doing nothing isn't really going to be helpful.) My therapist said I should go for the "Acute Partial Hospitalization" program and NOT the "dual diagnosis" program. The dual diagnosis program is for those that have a mental health disorder and substance abuse problem/addiction.
The partial hospitalization program would be 5 days a week, 6 hours a day, mostly group therapy, with individual counseling and meeting with a psychiatrist. I'd be able to start a day or two after they determine I'm eligible, I imagine. I'd be going in for some period of time, the average supposedly being 15 days but with some patients staying for up to 5-6 weeks.
When I saw my therapist on Tuesday she referred me to the partial hospitalization program at a local hospital. I called on Tuesday, and when the program therapist returned my call on Wednesday, provided some introductory information - current problems, medications, current drug use, demographic/insurance info, etc. I made an appointment to talk more in-person the same day. On the phone call I mentioned that I had used marijuana in the past (as recently as a few months ago) and currently drink alcohol a few nights a week. It turns out that based on the phone call they want me to go into the dual diagnosis program. They didn't mention this to me until the end of the in-person assessment, but they had all the papers ready to go for the dual diagnosis program in the folder they had given to me when I walked in.
Anyway, I talked with the therapist about my symptoms for about an hour, describing my current issues and how they have progressed, past psychiatric history, past drug use, any family issues growing up etc. I explained that I'd used more drugs in the past, but have not done so as of 2013. She asked for consent to talk to my therapist and psychiatric nurse practitioner, and I agreed. She then asked how soon I'd be able to start the program, and I said immediately.
At the end, when finishing out the paperwork, she mentioned that the dual diagnosis program would require me to attend outside meetings at a drug support group. This is something I do not want to do. They also mentioned that there would be random drug tests. I told her I do not want to attend this program, and that my therapist told me that the dual diagnosis program was not for me. The intake therapist said she would talk to my regular therapist about that. I don't feel like I have a drug problem and I think my friends and other psych care providers would agree. She said that I was a likely candidate for partial hospitalization but that the decisions were up to someone else - she just collects information, contacts the other providers, ensures insurance eligibility, etc., so now I'm waiting on a call back, hopefully tomorrow, and hopefully in the morning so I can figure out what I'm doing for the next few weeks so I can appropriately handle work and family obligations. In any case, I do not want to do the dual diagnosis program.
I'm not entirely sure what to do at this point, if I don't get in to the regular (non-dual diagnosis) program. I could press on my regular therapist/psych nurse practitioner to get them to change their minds. Or I could try again at another hospital, which would be inconvenient for me given location.. Or I could try something else. Maybe try to get time off work anyway and go back to Wellbutrin and hope things get better? I don't know.
Posted by sleepygirl2 on June 6, 2013, at 16:20:39
In reply to Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 3:48:43
I would tell them that you will not agree to the dual diagnosis program. It is, after all, for you, and you have to make the decision for the type of treatment you'll accept. The partial hospitalization thing, overall, sounds very productive.... Much better than an inpatient hospitalization (waste of time).
Good luck. Don't accept what you don't want.
Posted by antennastoheaven on June 6, 2013, at 18:04:56
In reply to Re: Is partial hospitalization right for me? » antennastoheaven, posted by sleepygirl2 on June 6, 2013, at 16:20:39
They won't accept me into the regular program, just the dual diagnosis program. I'm not happy about it.
One of the reasons was because I got drunk *once* in the past year and missed work because of it and they consider it substance abuse.
The only other thing is past marijuana use, and I stopped months ago.
Posted by sleepygirl2 on June 6, 2013, at 21:03:49
In reply to Re: Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 18:04:56
That sucks. I'm sorry.
Will it be a waste of your time?
Posted by baseball55 on June 6, 2013, at 22:03:09
In reply to Re: Is partial hospitalization right for me? » antennastoheaven, posted by sleepygirl2 on June 6, 2013, at 21:03:49
I also wonder if it's worth your while. I was in a day program and occasionally we met together with the dual diagnosis program. The people there were really drug and achohol addicts and were very different in their needs and problems from the rest of us. I think you should hold out for a regular program.
Posted by antennastoheaven on June 7, 2013, at 0:09:36
In reply to Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 3:48:43
I declined the dual diagnosis program. My therapist even tried to talk to the hospital but they wouldn't budge. Now she wants me to try programs at other hospitals. I already called one and have an appointment for an assessment on Monday, but after this upsetting experience with the first hospital I don't want to do it anymore. I'm fairly sure the hospital I just called isn't as nice, and it's like 20 miles away (and I have one other choice that's even further.)
I'm at five days of missed work and have only gotten worse...been crying a lot... and I don't think they will write up the paperwork for my absence from work without me doing some kind of treatment.
Posted by antennastoheaven on June 7, 2013, at 0:14:05
In reply to Re: Is partial hospitalization right for me?, posted by baseball55 on June 6, 2013, at 22:03:09
This dual diagnosis program seemed to be mostly the same as the regular partial hospitalization program, but with a few different components only for the drug group and added requirements for random drug testing and mandatory attendance at outside drug abuse support groups.
I refused to go to this program on principle.
Posted by sleepygirl2 on June 7, 2013, at 9:00:47
In reply to Re: Is partial hospitalization right for me?, posted by antennastoheaven on June 7, 2013, at 0:09:36
I'm sorry.
I'm wishing you luck.
Posted by antennastoheaven on June 11, 2013, at 2:42:13
In reply to Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 3:48:43
I went to a different hospital today (much further away but luckily not that much longer to get to, physical facility not as nice) for an assessment and they offered to let me into the partial hospitalization program or the half-day program. I just have to call back and let them know when I'll want to start, and they'll get insurance authorization and I can start.
I was so upset when I was only offered the dual diagnosis program at the other hospital, but woke up the next day not feeling nearly as depressed and have felt better ever since. So I kind of wonder whether the program is still necessary. I still intend to go.
Posted by sleepygirl2 on June 11, 2013, at 22:19:55
In reply to Re: Is partial hospitalization right for me?, posted by antennastoheaven on June 11, 2013, at 2:42:13
I hope it works out well, and glad your mood felt lighter too.
Posted by antennastoheaven on June 16, 2013, at 1:14:52
In reply to Re: Is partial hospitalization right for me?, posted by baseball55 on June 6, 2013, at 22:03:09
> I also wonder if it's worth your while. I was in a day program and occasionally we met together with the dual diagnosis program. The people there were really drug and achohol addicts and were very different in their needs and problems from the rest of us. I think you should hold out for a regular program.
I just started a regular program (not being considered a dual diagnosis patient) and it turns out a lot of the patients are dual diagnosis. Maybe a majority of them. I think the program content is probably about 85% the same (for the group therapy component which is the main part) and the dual diagnosis patients are in separate groups for only a few hours a week. Of course the dual diagnosis patients are probably obligated to attend addiction support group meetings, and they are subject to "random" drug/alcohol tests too. Is "random" whenever the people running the program suspect something? A random day every week?
Had I known the two programs were so mixed together at this hospital, I might have checked with one other hospital to get the details on their program. I would have attended a (non-dual) program either way - but I'd have preferred to go to one with less dual diagnosis patients in it.
It's really hard to relate to the dual diagnosis patients' stories. People talking about going to NA/AA meetings? I can't connect with that. 12 step programs? Talking about a "higher power"? I feel like I'm in church. I'm already distant from society, and I feel that having to going to addiction support groups would make me feel worse and further push me away from people... So I'm glad I refused the dual diagnosis. I can at least relate to experiences of withdrawals, but the only withdrawal problems I've ever had are from substances readily provided by the hospital: psychiatric medications (used as described) and caffeine.
I am doubtful that the program will directly help with my primary complaints (not wanting to do anything and not enjoying anything). But those are effects of a bad mood, and having a better mood won't hurt. It's hard to call the program a waste of time when I'd probably be spending 12 hours a day in bed otherwise (and possibly losing my job), but will it be a waste of my insurance company's money? Maybe. I'm hoping for improved interpersonal skills. And maybe it will get me leaving my apartment to do things more often. I'm already feeling better about myself if only because compared to a lot of people in the program I'm doing well. Ultimately I think it will be the medications that get me going back to work again, though.
--
One other complaint. I told them when I started that I occasionally drink, non-abusively. All patients are expected to abstain from drugs and alcohol, and subject to "random" drug/alcohol testing. They didn't tell me that until after I started, although I should have guessed that this would be the case. Would they drug test non-dual diagnosis program patients without a reason? I don't intend to stop drinking as this is a social activity. Every morning each person has to say whether they've used drugs or alcohol or not. Will I say "yes I drank last night" or lie about it?
Posted by baseball55 on June 16, 2013, at 20:09:33
In reply to Re: Is partial hospitalization right for me?, posted by antennastoheaven on June 16, 2013, at 1:14:52
I was in a regular (non-dual-diagnosis program) and they did random urine tests. I came in one morning and the psychiatrist said I tested positive for alcohol. I told her I made shrimp scampi (with white wine) the nignt before and had a glass of wine with dinner. But so what? It pissed me off that they were checking on me in this way when I wasn't there for substance abuse.
Posted by sleepygirl2 on June 16, 2013, at 21:21:55
In reply to Re: Is partial hospitalization right for me?, posted by antennastoheaven on June 16, 2013, at 1:14:52
They probably won't test you unless they think they have a reason. Should you lie anout drinking? I don't know. I usually try to avoid lying, but it is necessary at times. Do you see yourself going there much longer?
You know a psychodynamic sort of group might help with interoersonal stuff. I go to one, once a week. It's all about relating to others in the group, communication, examining how you react to others, etc. Sometimes they're hard to find, but if you google the American group psychotherapy association, they may have a referral directory.
Posted by antennastoheaven on June 17, 2013, at 0:16:41
In reply to Re: Is partial hospitalization right for me? » antennastoheaven, posted by sleepygirl2 on June 16, 2013, at 21:21:55
> They probably won't test you unless they think they have a reason. Should you lie anout drinking? I don't know. I usually try to avoid lying, but it is necessary at times. Do you see yourself going there much longer?
I'm two days in and patients are generally there for 4-6 weeks. Unless they decide I'm not really that depressed, I expect to be going for at least three more weeks.
And it's true, I'm not really that depressed anymore. Not having to work makes me feel good. Actually I think it was the medication I was on causing issues, and that I could probably go back to work tomorrow.> You know a psychodynamic sort of group might help with interoersonal stuff. I go to one, once a week. It's all about relating to others in the group, communication, examining how you react to others, etc. Sometimes they're hard to find, but if you google the American group psychotherapy association, they may have a referral directory.
They have a directory of psychotherapists but not of groups.
Posted by sleepygirl2 on June 17, 2013, at 7:40:17
In reply to Re: Is partial hospitalization right for me? » sleepygirl2, posted by antennastoheaven on June 17, 2013, at 0:16:41
I usually feel better when I'm not working too. It's the stress thing for me. Working while depressed can be pretty grueling.
I had to contact each therapist inquiring whether they had groups before I found mine.
Glad you're feeling better.
Posted by antennastoheaven on June 19, 2013, at 2:47:42
In reply to Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 3:48:43
I'm starting to question the utility of me being in the program even more. I don't think there's enough content useful or relevant to me specifically - I'm too far away from the average patient. I have such a limited set of emotions and no real problems aside from depression, anxiety, and ADD, the last two of which I have under control with CBT and Adderall respectively.
Everyone else seems to have issues with drugs, family, stress, work, relationships, health, or trauma, often with a specific event leading up to them being in the program. And I can't relate to most of their stories. This makes group therapy not very useful, and general discussion of issues accounts for almost half the program. I end up hearing the same stories and explanations multiple times from the same people as they re-explain everything whenever some little detail changes. Sometimes, it seems the group spends a long time discussing a single person's issue. And sometimes repeatedly. The other day I didn't get a chance to discuss what I wanted to because of this. The most I get from many of these stories is reassurance that I'm doing a lot better than some others. I think group therapy could be very helpful if only the group was comprised of people with similar issues - which seems like it would be difficult to find.
10% of the program is CBT and 10% is DBT (dialectical behavior therapy). CBT is good and it has helped me in the past, but there's so little of it. DBT seems like it might be useful for helping with emotional issues but since I experience few emotions I don't have the kinds of problems it seems to be geared towards solving - I think it might help me a little bit, but I think I'd get more utility out of more CBT.
I feel like I would get more benefit seeing an individual therapist four to five days a week; but short of offering cash to see someone outside of their regular business hours, it seems like it would be very difficult to schedule. And finding one I like who would do that might take a while. It would be nice, however, to be able to pick my own psychiatrist instead of having to deal with the one assigned to me by the program; I'm not sure if the psychiatrist I was assigned is right for me. Are there any other treatment options that don't involve so much group therapy? Is it possible to see the same therapist for 4-10+ hours a week? Would it even be productive past a few hours a week?
Staying in the program is going to make the people filling out the disability paperwork happy, and probably looks better for my disability insurance claims, and it's better than doing nothing all day. Full disability income and job protection lasts for 12 weeks, so there is no pressing need for me to return to work. So unless I figure out some alternate treatment that's going to be more useful and seems to be worth the cost, I may as well keep going along and try to make the most of it until I feel I'm able to work again.
Posted by baseball55 on June 19, 2013, at 20:09:27
In reply to I'm thinking this program is inappropriate for me, posted by antennastoheaven on June 19, 2013, at 2:47:42
The first time I did a partial hospitalization program, I felt exactly as you do -- I have nothing in common with these people. The second time, I was more subdued after a suicide attempt and two weeks inpatient and I realized that part of the whole point of groups is to learn empathy and compassion for oneself and others. The first time I was arrogant and convinced I was different. The second time, I was humbled and felt I needed to listen and learn.
As far as a 4 day a week therapist goes, I found my DBT therapist by going to my insurance company's website and searching on DBT. You could also search on CBT and find probably dozens of therapists. It's just a matter of calling, seeing if they have time and making an initial appointment to see if they can work with you.
Posted by Dr. Bob on June 19, 2013, at 23:18:37
In reply to Re: Is partial hospitalization right for me? » sleepygirl2, posted by antennastoheaven on June 17, 2013, at 0:16:41
> > if you google the American group psychotherapy association, they may have a referral directory.
>
> They have a directory of psychotherapists but not of groups.The "Affiliate Society" in your area might have a directory of groups, or someone who could help you find one:
http://www.agpa.org/about/affsoc.html
Bob
Posted by antennastoheaven on June 20, 2013, at 1:57:12
In reply to Re: I'm thinking this program is inappropriate for me, posted by baseball55 on June 19, 2013, at 20:09:27
I understanding what you are saying and I'm listening and trying to learn... I was in a generally better mood today and felt more connected, and even brought up in group that I was having trouble relating to a lot of other people's stories. But I'm still convinced that I am truly different.
(going off topic on my own thread) I have a serious lack of empathy as-is, not sure if the program can possibly help with that. People have broken down crying a few times and I have felt nothing. Properly dealing with people who are grieving (or celebrating) is not something I can do; when someone at work or in my family has a relative die, I don't talk to them and don't express sympathy because I don't know how and don't feel anything. I don't do anything even when people tell me to call someone or send a card or whatever. When my parents die I don't expect to feel much, and I'm worried about how I'm going to appear to others when it happens (assuming I outlive them...). I can't respond when people are celebrating something big like having a child. I never bring it up - can't even manage to say congratulations. I also find it very difficult to praise others and receiving praise typically makes me uncomfortable. These issues don't really bother me, but I suppose they are things I can try discussing in groups.
These kinds of things are indicative of schizoid personality disorder, which I am diagnosed with according to my online health record (I have never actually been told about the diagnosis, though). Since I'm not supposed to know about the diagnosis, I didn't tell the hospital about it when I started the partial hospitalization program. I feel the diagnosis is correct, though, and that schizoid symptoms do make me very different. So I feel this could be a real barrier to getting much out of group.
I also feel very different than everyone else in that I didn't have any stressors that led to me being in the program. If I was going because of a suicide attempt, or some life event like a breakup or loss, or some kind of psychosis or delusion, then I would feel like I fit in better.
Posted by antennastoheaven on June 20, 2013, at 2:01:58
In reply to Re: Is group psychotherapy right for me?, posted by Dr. Bob on June 19, 2013, at 23:18:37
Thanks. I found groups in my area. Whether any of them are appropriate for me is the question now. And if I think I've found something that might work, it will take some work to find the motivation to actually join.
Posted by antennastoheaven on July 8, 2013, at 0:19:08
In reply to Is partial hospitalization right for me?, posted by antennastoheaven on June 6, 2013, at 3:48:43
I've been going to the program for over three weeks now. I was on PHP (5 hours a day) for two weeks, then dropped down to IOP (3 hours a day). Although I'm doing better than I was when I started this thread a month ago, I'm tired of going to the program and think I might drop out.
I'm OK now mainly because of medication. Unfortunately it's mostly just the same medication I was on a few months ago, which makes me functional but still leaves me unhappy; I did get some better ADD medication, though. The psychiatrist is unreliable, which has been an annoyance. The last time I saw her, the discussion was abruptly cut short, so I didn't have a chance to ask about when she might discharge me. During the previous week's visit, I said I wanted to get an effective ADD medication before finishing, and now I have that.
I don't get much out of the group sessions. My previous comments about not being able to relate to other group members still hold true. I haven't gained much of anything from hearing other patients talk about their issues. I've participated in group and tried to talk about my issues, but the feedback I get isn't very valuable - many times the only helpful commentary I get is from the group therapist. Educational content is minimal, and not very in-depth... the CBT topics we discuss are things I have already learned. I gain much more from weekly individual sessions with a therapist and using online resources and discussion forums.
I have not met all my treatment plan goals and don't expect to no matter how long I am in the program. This doesn't seem to matter, because it doesn't seem like treatment plan progress is ever reviewed by the staff... patients self-report progress every week, but there is no feedback from the therapists and no actual revisions to the treatment plan seem to be made. The only time I have talked to a therapist about progress in the program is when they are re-authorizing my stay with the insurance company, and the treatment plan has never come up during that time.
I've already mentally checked out from the program. I thought about it a lot this weekend and came to the conclusion that it's not helping. I really don't want to go at all anymore. I'm not sure if I can hold out until Thursday, which should be the last day my insurance company has authorized, and would be the first day I could be discharged since I should see the psychiatrist on Wednesday. Right now I'm considering telling them I am done when I go in tomorrow. My main concern would be with the insurance company - they will receive discharge information and will know that I dropped out. Would they do anything if I quit on my own? I suppose they probably would not authorize another intensive outpatient/partial hospitalization program in the future. My regular therapist and psychiatrist would also get notified that I dropped out, but this is less of a concern, as long as the psychiatrist will still write a note saying it's okay for me to go back to work. If I don't quit tomorrow, I do not intend to stay past Friday, as I'm expected to return to work in a week. I could extend my leave and disability if I felt there was value in it.
I now question whether I should have been referred to the partial hospitalization program in the first place. My depressed mood at the time I entered was the direct result of a medication I had started a month earlier; discontinuing that medication and going back to my previous medication was all that I needed to be functional again. The program was useful in giving me structure and responsibility during the time I was adjusting medications, but it only took me a few days to become functional once again. The core component of the program is group therapy, and I don't think this is effective for me due to personality (schizoid) and my specific depressive symptoms. I think my therapist should have been able to predict that I wouldn't get much out of the program; maybe she did, and wanted me to go to a higher level of care anyway. The program is not a good value for me given the high cost, and I think the money spent on this program would have been better used on TMS (if only the insurance company would pay for it) or more frequent individual therapy.
Posted by antennastoheaven on July 9, 2013, at 13:05:45
In reply to The program has not been very useful, posted by antennastoheaven on July 8, 2013, at 0:19:08
I decided to drop out of the program yesterday (Monday). I talked to one of the therapists after the last group session, expressed my concerns with group therapy and the psychiatrist, and she said I should wait to see my psychiatrist and get officially discharged, but if I really wanted to, we could fill out the discharge paperwork today. She warned that the insurance company may not pay the claim if I quit against medical advice, though... which didn't sound right to me.
I actually called the insurance company right after that. They told me they would pay for any days I attended as long as the hospital had pre-authorization. But then they called me back a few minutes later and told me they didn't have pre-authorization for me to be in the program at that hospital. I talked to a representative who looked at the notes, and it turns out that the hospital did call the insurance company like they were supposed to... and the insurance company mistakenly told the hospital that they didn't need to pre-authorize me. Oops. So the hospital company has to re-submit the preauthorization, and the insurance company will allow them to backdate it.
After I got off the phone with the insurance company, I talked to someone else in the hospital and told them about the insurance situation. They insisted I come back today (Tuesday) and talk to the person who deals with insurance companies, who was out for the afternoon.
I went in this morning and talked to the correct person, who was extremely courteous and understanding. She said the insurance company was correct in that they will pay a properly pre-approved claim regardless of the reason the patient discontinues treatment. She filled out just one discharge form for me to sign and take with me, listed the reason as "dropped out to return to individual therapy", got the info for my therapist and psychiatrist and consent to fax them records, and listed all the medications I am taking. They'll send a treatment summary along with the discharge form I signed, and that's all. The process of leaving gracefully was easier than I thought it would be.
Now I just have to get a note to go back to work from the nurse practitioner who filled out the original leave paperwork, and I can get on with my life.
Posted by Dinah on July 9, 2013, at 13:22:21
In reply to Dropped out, posted by antennastoheaven on July 9, 2013, at 13:05:45
Great! It sounds as if these last people you spoke to were really helpful.
Experience with a family member tells me that it's hard for a facility to let people go even when circumstances change, so long as they are authorized.
This is the end of the thread.
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