[yellowfrog268]

Hello,

I've never posted to this particular forum before but recent events have me confused.

My teenage daughter is seeing a therapist. She has had eight sessions now and the therapist (PhD) feels pretty confident in her diagnostic impression.

Yesterday, I took my daughter to a psychiatrist (at the urging of the therapist) to be assessed for medication.
After the session, I spoke with the psychiatrist and found out that she has a different diagnostic impression. I mentioned what the therapist thought and asked for her opinion. She basically said she doesn't agree with the therapist.

I also mentioned that the therapist told me that she'd like to be in contact with the psychiatrist for continuity of care reasons. The psychiatrist said that she doesn't need to be in contact with the therapist.

Now, I don't know what way to turn with respect to my daughter's care.
I have two licensed professionals who disagree on diagnosis and one does not care to talk to the other. Both are highly recommended in their fields and my daughter seems to get on well with both.
How do we move forward with this situation?
Has anyone else had something similar happen to them? How did you resolve it?
Our insurance plan is fairly limited in numbers of providers that specialize in adolescent psychiatry and psychology for my area. We cannot travel long distances for care so we have to make due with what's available to us.

[Freewilled]

Which diagnostic impression resonates with you more? Which professional do you have a better rapport with? Maybe get another opinion. I disagree with the psychiatrist, because IMO, they should be open to collaborating to ensure continuity of care. That's just standard practice.

[UnderRugSwept]

I would be wary of a psychiatrist ready to diagnose so quickly, especially in anyone under 18 (I am guessing here), and prescribe her meds. I am not saying she isn't right, it would just make think that a second opinion from another psychiatrist might be helpful since this one doesn't think speaking with your daughter's therapist would be helpful or necessary, especially after a varying diagnosis...it seems very odd!
And kudos to you as parent for being so careful and attentive.

I would have to have the two both willing to consult with each other. They wouldn't even necessarily have to agree on diagnosis (that isn't particularly unusual), but the willingness to consult on occasion would have to be there. My T and Pdoc consult. My husband's T and Pdoc consult. My son's T and Pdoc consult. My husband's GP and pain specialist and pdoc and T ALL consult. It isn't an unusual practice. Your pdoc comes off as a bit arrogant and not patient centered. I might see if there is a better option. Don't leave this one until you find another, but certainly investigate your options.

[TheWell]

My Psychiatrist, Group therapist and individual therapist all communicate about me to each other. I believe that Having them working as a team has been extremely helpful to me.

As for diagnosis, I wouldn't worry too much. I have two different diagnosis that they all don't agree on but the Meds can be used across the different diagnosis. If a med doesn't work you try another. It's not an exact science like this specific med only works for this specific diagnosis.

[HazelGirl]

My psychiatrist is through my insurance and my therapist isn't. My Pdoc refuses to speak to my T. It's very annoying. But my Pdoc basically rubber stamps everything my T says because she doesn't see me as much as my T. I wouldn't trust my Pdoc to diagnose me. The therapist sees your daughter way more than the psychiatrist, and a lot of psychiatrists are very narcissistic and selfish. I would find one willing to work with the therapist and willing to spend enough time to figure out what is really going on.

[Leah123]

All things being equal, a therapist with eight hours to work with your daughter is eight times more qualified to diagnose than the psychiatrist, and I would give her conclusions more weight. Also, if the psychiatrist does not want to be a team, I would go for a second opinion, or at least report all of this to her therapist for some assistance resolving the discrepancy and impasse. It's important the two providers maintain some contact.

[owlpride]

My psychiatrist and my therapist have given me different diagnoses but I'm not terribly concerned about that. None of my diagnoses are "significant" (just standard mood and anxiety disorders) and I feel adequately treated by both providers.

Now, if either had given me a diagnosis with significant implications (e.g. a personality disorder or schizophrenia), I would follow up on that. I would also follow up if the two diagnoses were at odds with each other. For example, a friend of mine was diagnosed with generalized anxiety disorder by one provider, and ADHD masking as anxiety by another provider. Since those diagnoses have "opposing" treatment strategies (e.g. stimulants for ADHD, benzos for anxiety from a medication perspective), he needed to get that resolved before comitting to a course of treatment.

[Lauliza]

I think it really depends on the diagnosis and what either diagnosis means to you. Will one qualify your daughter with a better treatment plan than the other? Do you agree with putting your daughter on meds? Phd s are usually the ones with more experience in diagnostic testing so I'd lean toward their assessment. You have the right to tell this p doc you disagree with them. They are not more qualified just because they are an md.

[punkybrewster6k]

I know here where I live, both pdoc and T usually need to be in the same network to share and access files. If not in the same network, its much harder to get them to do that.

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[owlpride]

Also, psychiatrists may be biased towards diagnosing based on the symptoms that they can/want to medicate. For example, my Pdoc is officially treating me for PTSD. T doesn't think that I have "proper" PTSD, but the medication I am getting is helping me. Since Pdoc only writes scripts, I don't care if he knows the full picture. That's T's job. (I am on SNRIs + benzos, which are prescribed for a wide range of mood and anxiety disorders, so the exact diagnosis doesn't really matter in my case.)

If the difference in diagnosis is important in your case, I'd definitely follow up and try to coordinate between the two professionals. It might help to get a third opinion if possible.

[growlycat]

I would be wary of any provider unwilling to talk to another. Can her main therapist offer a referral/suggestion of someone they work well with? It would be better if both pros were on the same page.

[yellowfrog268]

Interestingly, her therapist is the one who recommended this pdoc. They work in the same complex and know one another.

I think that I will give this pdoc a little more time before deciding to go elsewhere. I will talk to my daughter's therapist though and let her know that my daughter had her first visit and see if the therapist reaches out to the pdoc.

[Truck33]

When I started therapy I was not yet seeing a psychiatrist... But a few months I started .. The first thing my therapist asked me was to sign a consent form so she could speak with the psychiatrist .... When I went to see the psychiatrist the first thing he asked was for me to sign a form so he could speak to my therapist.....

So with that being my experience I think it could be important and it's is normal for them to collaborate .. I think it gives a better picture of the situation so they can help in the most effective way they can

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[H3rmit]

Originally Posted by 1914sierra

Your pdoc comes off as a bit arrogant and not patient centered.

Yeah, really. It doesn't matter that the pdoc doesn't need it. It matters that the client needs it.

[nottrustin]

My T and pdoc have different diagnoses for me... My T admits she is not specialized in this area but pdoc is. She came up with my diagnosis based upon her experience over the last 40 years and seeing me weekly for 50 minutes each. Pdoc came up with the diagnosis based upon what she sees but she sees me about every 6 weeks for about 1/2 hour...however, I also use to work on the same unit as her so she we have talked outside of those sessions.

[Perna]

I would look at the two diagnoses and see if they could be complimentary or related; if it were depression and anxiety, for example, I would not have any trouble with a doctor prescribing for what the doctor sees and the therapist working on what they see from their end, etc. To my thinking, nothing is "pure" and simple with only one cause or effect and every little bit helps; I would try the medication and see if you, your daughter, the doctor and the therapist (in that order) believe it helps and is worth while. You know your doctor works well with her therapist so that is not a problem? I don't know that the therapist and doctor have to work together, other than to agree the medication helps your daughter, but you and your daughter will be the best judge of that.

[Auntie2014]

I think it depends on purpose/intentions of Pdoc. Some only do meds regulation and others do both meds and therapy. If intent of Pdoc includes therapy I can see why they might not want to work with her therapist of record.