Pdoc/T: 'Tough Love' or Bully???

My sentiment exactly- only much better phrased

I do wonder, however, why is he taking you off your meds...

Probably because she's been taking unprescribed meds and he wants a baseline and her system clear before he changes things up. Not particularly unusual. My husband's Pdoc did the same with him. My pdoc has actually done that with me because he didn't feel the mixture of meds was working for me and he wanted a clean slate so to speak. It was at that point that he was finally able to get my medications on board effectively.

I think he sounds arrogant. And I think he probably misses a lot because of it. Did he even ask you how you felt on abilify? It sounds like he needs to be the expert and call the shots and thinks that he holds all the knowledge and you hold none. People who pride themselves on "playing hardball," IME are often compensating for having crappy social skills. "If I sound like a jerk it's because you can't handle the truth and you're too sensitive--there's nothing wrong with me!" It's like he doesn't see it as his repsonsibility to establish rapport with you.

Dump him. He's rubbish.
As for those who recommended him, you should should recommend that they don't recommend him again.

Thank you, I must admit that I don't have much experience with BP/any MI requiring constant medication/ treatment. I was worrying about her not being medicated at all (also, I thought the self medication was a one time, long finished "experiment").

It sounds like she's not terribly stable on the meds she was taking (just guessing as she didn't name her prescribed meds), so it probably won't make a huge difference at one month except to clean out her system so he can start over. It may be (again only guessing) that the primary care doc's choice of meds were not right at all which is a common problem with using a PC for psych meds.

He is questioning your bipolar diagnosis.

Just wondering. Where do you get that impression. The non-compliance and med issue is very common in bipolar. I assume he is just commenting on the difficulty in treating her if she doesn't adhere to treatment.

He's an asswipe no doubt about it.

Thanks for your response, Freewilled. It's true, I certainly wasn't explaining myself in a circuitous manner on purpose. He was attempting to get a sense of 13 years of history in 50 minutes time, and in doing so I had a tendency to say things like "depression" and "manic" rather than stating explicit SYMPTOMS of depression and mania. This is force of habit. With practice I should be able to get better at catching myself when I'm about to use labels instead of symptom descriptions.

You summed up how I perceived his attitude very nicely, thank you for that.

Thank you for your thoughtful response. I was seeking opinions because I can see both sides of the argument for and against this pdoc. I did not disagree with his approach to treatment (taking me off meds to get a baseline, suspending judgment on a diagnosis until he has a more complete picture, and recommending regular psychotherapy).

As I explained in my last response, the circuitous explanations on my part are certainly not an attempt to manipulate, rather an unintentional pattern of speaking that I did not realize was unclear until it was pointed out to me. I don't have a problem working to be more clear - it will probably take practice though. It's funny - I always thought of myself as articulate, so this was surprising feedback.

My problematic alcohol use occurred in college, and ended over 10 years ago. Sadly, binge drinking was the "greek" culture at the college I attended. I'm not blaming "peer pressure" entirely for my behavior--it was still my choice to go along with it--I just didn't think what I was doing at the time was wrong or dangerous since my sorority based its entire social agenda on getting drunk.

I understand all of the red flags presented, and why he would want to safeguard himself against liability as well as wasted time with a patient who cannot be effectively treated due to misuse of non-prescribed substances or alcohol abuse. He also ordered blood work and a urine tox, both of which I complied with and will at least show him I did stop taking my previous medications (Celexa and Buspar), and also am not taking any non-prescribed medication.

I'm keeping an open mind because I want nothing more than to get on with my life and be well. I won't immediately shut a doctor down because he made me feel defensive and misunderstood. I hope I can handle a struggle and a few bruises to me ego if it means I can finally be well. The worst that can happen is this doctor truly is a poor fit and cannot help me.

That being said - it's painful to be put in the "guilty until proven innocent" category. I believe that if this doctor is able to get to know me, his fears about me being a waste of time/med abuser/problem drinker/liar/manipulator/all around difficult patient will dissipate. At least I hope so, because I don't see myself as any of these things. I see myself as a sensitive but determined woman who is sick to death of being sick.

I don't feel you were 'all' guilty until proven innocent. Binge drinking 10 years prior, considering the greek lifestyle(which I get ) perhaps, your pdoc has a 'dry sense' of humor.
I am not saying in any way, that you purposefully, were circuitous. Perhaps, this is the type of therapist, to help you become less so. Your intent isn't circuitous, but your communication style is. He could be a great resource to help you overcome this!!

I am glad you are taking an open minded approach. Maybe, it will take some time, to find a working relationship, with this one.

Think of some of them, like brainiacs. If you were greek, what was he?!

Humanize him, for the moment, and recognize, he's there to help you become the person you are struggling hard to become.

Thanks again, F. Just to clarify, I felt HIS approach was to view me as guilty until proven innocent. It just may take some time to develop a therapeutic relationship. I am hopeful that will occur, and at the same time fearful of wasting MY time and having to start over (yet again) if we can't make progress.

Recovery takes a tremendous amount of faith, surrender, and patience, doesn't it?

It does

It does take time, to develop a therapeutic relationship. In many cases, jumping around from pdoc to pdoc isn't much of an option. There really aren't a lot, even where I am. And sometimes, working through a personality conflict, can feel liberating, in the long run. As you begin to assert and express your needs. It carries over, into other areas of life, I have found.

For instance, my stepmom, went to a neurology appointment, one time. And her impression of him, compared to mine, were like night and day. She came away with the impression, 'oh he's just a know it all, isn't he?' and I was astounded. I see him, as highly intelligent, but to me, he's not condescending nor does he push my buttons. Apparently, he pushed her buttons; we both heard the same words, just took things, differently on an emotional level.

In my experience, we all need a healthy dose of nurturing and a kick in the a $$ to make changes in life.

I am so hard on myself that I need nurturing from my therapy. Because I need to learn how to be kinder to myself. However there were times in my life where I approached decisions of life and career with too much entitlement and I'm grateful to those mentors who had the balls to tell it to me straight.

Some came from a place of truly caring about me, and others came from a place of not liking me very much. I learned from them all and only kept in touch with a few.

Take what you need and quit when you want.