[enigma17]

At my assessment appointment with my new therapist, with whom I felt instant comfort, he diagnosed me with OCD, referred me to a psychiatrist and advised that at our next session we would be using Rational Emotive Behavior Therapy. I researched REBT and felt optimistic about the doctrine. However, when I had my first visit with the psych, with whom I also felt an immediate rapport, I asked him what his take was on REBT and he said he found it quite effective but it was NOT FOR ME. He said it's approach was to teach people to think more, and I was too intelligent (pardon my immodesty) and I already think too much.

I have my first "work" session with the therapist tomorrow and I really would appreciate some of your insights re: should I tell him my MD disagrees? I mean, he may have a rebuttal that makes perfect sense and then I will feel more confident about REBT. Or he may think me noncompliant and we'll be off to a bad start. Should I keep it to myself and give it a try (i.e. be a "Good Girl")? Does that make me dishonest and put me in danger of thwarting my own therapy?

Am I overthinking this, too?

ANY insights are appreciated.

Enigma

[(JD)]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
when I had my first visit with the psych,

</div></font></blockquote><font class="post"> I take it your therapist is not a doctor? And this "psych" refers to a psychiatrist?

Either way, I would certainly discuss it with your T. I wouldn't necessarily counter the T, saying the psychiatrist disagrees, but that you asked him and he thinks you "think too much already." That should lead to a full discussion of what your T plans with using this modality, which you should have anyway

In general, psychiatrists lean more and more towards only prescribing, and less towards behavior counseling, whereas therapists utilize approaches they are familiar with and stay updated on. Good wishes!

what is your gut feel about what you need? They both have only seen you 2 times, so maybe one solution is to let the therapy go on for a few session, and then discuss.

[enigma17]

You are correct - my T is licensed but not an MD and by "psych" I mean Psychiatrist. I'm new here and a little unsure about the shorthands I've seen, such as Pdoc and SKR. I don't want to assume and come across as a rube, but I guess I did anyway. Anyone care to enlighten me?

[enigma17]

My "gut" is that I have tried therapy a few times and have never felt more instinctively comfortable with a T. My lifelong pattern, though, is to do anything not %#@&#! people off (abuse as a child, abusive marriage [yawn]).

[(JD)]

<font color="darkblue">Oh no, you didn't come across as rude at all!

Psychologists aren't MDs as they don't have Medical Degrees, but they often have PhDs (doctorates in philosphy) or PsyDs (doctorates in Psychology) and therapists usually have at least a Masters degree with licensure and supervision... but there are plenty of mixes and matches out there!

Well, there is no one concensus here, yet... as to Pdocs... Primary Doctor or Psychiatrist. I think we use it at PC as the person writing the Scripts! lol

I'm glad you feel comfortable with your T. Many Ts adjust their method according to the patient anyway...so you might ask if your T does that or if he/she is set firm on only the REBT or not. That you already found this out means they are open to discussion, imo.

[Sarah116]

Ignore nasty Psychiatrist and go with Therapist. Really some of them out there are just bad news! I have one also a nasty evil psychiatrist.

If I was you I would be signing release forms and setting up a meeting with both therapist and psychiatrist attending at the same time specifically for discussing your treatment options. By doing it this was all sides can hear all sides at the same time so that there is no he said she said confusions and you don't end up being pulled in two different directions. The purpose of having both a therapist and psychiatrist is so that the psychiatrist and therapists can BOTH help you with medication options and therapy options at the same time. They can only do this well if they have the same information of symptoms and problems and have contact with each other so that they are not contradicting each others treatment plans.

Another avenue that has worked out very well for me is that I don't see a psychiatrist unless I am undergoing comprehensive psychological evaluation testing and updating. My family physician prescribes my medication needs when needed and both him and my therapist have a release form signed and actice so that they both can contact eachother at any point to talk about me and my treatment programs.

[enigma17]

I'm not sure getting everybody in the same room will ever happen, because the psychiatrist is actually the medical director of a psychiatric hospital and only sees me as a favor to my therapist. And my therapist only sees patients at night, which is why I can see him because I don't drive and my husband chauffeurs me. But I will definitely ask to sign release forms so they can communicate via fax or telephone, maybe even while I am with one or the other. The releases are a brilliant idea and I thank you very much.

you're welcome, glad you are getting the release forms. it will help alot and teleconfrencing (having therapist call when you are there ) is a great idea. SKR and I have done that before and so have LL and on on some issues that came up surrounding various agencys that are involved in my life.

take care.

[JustBen]

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enigma17 said:
...I asked him what his take was on REBT and he said he found it quite effective but it was NOT FOR ME. He said it's approach was to teach people to think more, and I was too intelligent (pardon my immodesty) and I already think too much.

</div></font></blockquote><font class="post">

Your psychiatrist is just flat-out wrong about REBT. It's not about making people think more; it's about changing the way you think. It has nothing to do with how intelligent you are. He was right about one thing, though: it's very effective--especially for OCD.

If you bought what this psychiatrist was saying about REBT, then I'd definitely bring it up with your therapist. (Or, for that matter, do a little more reading on REBT and you'll see just how far off-base he is.) I know it's hard to disregard advice by an MD--we've all been conditioned to look to these people as major authority figures--but the reality is that most psychiatrists are only experts at writing prescriptions.

[wisewoman]

Exposure and response prevention is the treatment of choice at OCD clinics of which I am aware.

[jennie]

It would be a good thing to mention to your therapist your concerns about REBT and your doc's recommendation.

Intellectualizing stuff all the time is a defense mechanism, especially in therapy. I hope you try stuff. Maybe REBT will be beneficial, or maybe not. You'll never know what works for you without trying. I hope things go well for you.

When I'm afraid to cry, I'll think my way out of the feelings. For me, therapy would be more benefial if I allowed myself to feel and process the hurt feelings inside of me. I have a lot of hurts that I avoid.

[jennie]

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JustBen said:

Your psychiatrist is just flat-out wrong about REBT. It's not about making people think more; it's about changing the way you think. It has nothing to do with how intelligent you are. He was right about one thing, though: it's very effective--especially for OCD.

</div></font></blockquote><font class="post">

JustBen

[JustBen]

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wisewoman said:
Exposure and response prevention is the treatment of choice at OCD clinics of which I am aware.

</div></font></blockquote><font class="post">

Yep, and if the t is any good, this stuff will constitute the B of REBT.

[(JD)]

<font color="blue"> I'm not sure that debating what the MD meant versus what we know to be true about REBT is doing any good, but lowering your trust in the MD. As I said, psychiatrists don't usually keep up with the ongoing talk therapies, imo. It also, imo, wasn't his place to fully discuss the therapy another doctor/therapist would begin working with you on... yes, his comment might have been flippant.

My focus is that YOU need to discuss these questions with the therapist, and gain his understanding of how REBT will help you best. Each T tweeks any modality somewhat. I 've even met some Ts who say they use one method and find they aren't doing that at all!!! That's ok..but... you know???

I'm eager to hear about what you found to be true, and what you found to be misunderstood regarding your therapist and therapy TC!

[JustBen]

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_Sky said:
<font color="blue">I'm not sure that debating what the MD meant versus what we know to be true about REBT is doing any good, but lowering your trust in the MD.</font>

</div></font></blockquote><font class="post">

I don't think there's any debate, really.

I don't think anyone underminded the MD's expertise in medicine; but as far as talk therapy recommendations, I think having very little trust for this guy's opinion would be a good idea.

It's kind of like an accountant--they're primarily concerned with setting up the books, working out a payroll, getting the taxes done on time, etc. They're also allowed to give investment advice, too, but unless they're really good, they should probably keep their opinions to themselves and stick what they do best.

[(JD)]

<font color="blue"> Yes, if the therapist has a list of psychiatrists who work with him, then diss this one. My understanding of the situations in general is that psychiatrists are a shrinking breed and few GP MDs write or understand psychotropic medications. I'm just saying discuss this with the T, before burning any psychological bridges.

[Hopefull]

I'd concur on that, talk with T. Psychiatrists are really employed a lot of times to prescribe medications. Some know the talk therapies. But, I know that some don't.