Contradictions

Hi all,

I wonder if I could ask the community for their input on this situation I've found myself in. A year ago, I started going to a therapist because I was worried I might be clinically depressed. I didn't look around for different therapists, thinking that they are all pretty much the same. I went to the first person I found who ended up being (what I believe to be) my perfect match. However, after the first couple of meetings, he determined that I wasn't clinically depressed, but that I should keep coming to therapy because if I tried to work through some of my other baggage, what symptoms I did have (anxiety, low self-esteem, sleepy too much etc.) would go away.

I remember a particularly difficult session a few months ago when T asked why I started therapy. I said I wanted to be evaluated for depression especially since I know it can be genetic and one of my parents has bi-polar borderline personality disorder. T replied saying that I could have googled the symptoms and made my own conclusion so he asked again what was the real reason I came to therapy to which I didn't have an answer.

Fast forward to now. My fiance and I have been seeing a couples therapist. Our couples therapist is wonderful and it turns out she is also a very close friend of my T. At first, I was worried that she wouldn't be as good as my one on one T, but when I voiced my concerns to my T, he said that our couples therapist is a very close friend of his and that I could trust her and that he trusted her. So....when our couples therapist suggested I go see a psychiatrist, I trusted her opinion and decided to follow through. I told my one on one T about this and he said that he thinks the psychiatrist she referred me to is excellent and that if I felt like it was something I wanted to pursue that I could trust this particular psychiatrist.

After my first appointment with the psychiatrist, he determined that I'm clinically depressed. He said that it would take a few more meetings to determine which specific type of depressed (situational, uni-depressed, bi-polar depression, etc.) I am but that I am certainly a good candidate for medication and that we should go down that road. I'm feeling lost and somewhat betrayed by my one one one therapist. I don't know if I can trust his expertise anymore. I thought he was helping me and certainly some of my symptoms have gotten better although they come and go. I don't know what to do. Should I confront my T about my feelings? Is it normal to have contradicting diagnosis? I know psychology is more....dynamic (?) and pin-pointing a diagnosis can be challenging but I thought major diagnosis like this would be pretty clearly defined.

I dont think some Ts particularly like giving diagnoses and then that leading to medication. I think they aren't supposed to do it but I can hear what you are saying I think about why he didn't recommend you get that from elsewhere if that is what you wanted. Maybe he just truly believed what he was saying to you, that he didn't think it was clinical depression but that he could help you to manage your symptoms.

I think also that some people may just want to take medication and have everything go away, which I don't think actually helps the underlying cause of the depression or symptoms. For me, the work I am doing is going deeper to 'treat' the root cause and if I was medicated for my symptoms I wouldn't be able to tell if it was making any difference. I was medicated for depression at 14 against my will when all I really needed was for someone to actually bother to be there for me, to stick with what would have been pretty tough work, but that is a different story and, incidently, what Tuesday session will be about.

I don't know if that helped at all, but maybe just trust your gut.

I had almost the same thing happening to me. For a couple years when I was a teenager I only saw psychiatrists as it's easier to see them for free in France. I saw 3 different psychiatrists who all said to me I was clinically depressed and needed medication after only one appointment. Now, I've been seeing a psychologist for 2.5 years and he has never diagnosed me with anything, which I prefer. My guess is simply that their approach is different and their job is different. If you go see a psychiatrist, of course he will be more focused on medication. This doesn't mean you shouldn't trust your therapist. For me, I prefer someone who believes I can make it without medication and who is more willing to listen to me.

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True, I shouldn't be surprised by the psychiatrist being more prone to making a diagnosis, but I was told by both Ts that this psychiatrist is very conservative meaning he doesn't normally give out prescriptions so I guess I was a little shocked given that pre-cursor as well.

I can understand why you might feel confused and angry about the differing diagnosis.

Are you assuming the psychiatrist is right and the therapist is wrong? Could it be the other way around?

I don't feel it is uncommon for two different MH professionals to disagree about a diagnosis.

I also don't feel it is uncommon for a psychiatrist to diagnose a person with a condition for which they can prescribe medication. That's what psychiatrists know how to do- prescribe medication.

Yes, talk to your therapist. I'm not certain I would be confrontive. Maybe I would treat it more like information gathering. But you decide.

I kind of went with the more senior professional. My therapist is very young (30s) and the psychiatrist is older (60s) so I assumed the more experienced one would be correct, but you're right it could be the other way around. I guess I didn't understand the role of a therapist vs. psychiatrist. I always thought therapists would refer a patient to a psychiatrist if he or she thought it would be necessary (like my couples therapist did). I've never been on meds for anything before let alone a psychological reason, so I guess I'm not really sure how these things are supposed to work...

Disclaimer: I am not a proponent of psychiatric medication, and I only offer this thought from past experience.

What could have been happening is that your therapist sought to address your symptoms without medication first, which can often help identify what's psychological and what might be physiological. I think that's a good approach. A lot of mh professionals will diagnose and drug first, which leaves a lot of room for error. If you had gone to the psychiatrist first, he may have given you unnecessary drugs if, say, you could have gotten relief from therapy instead. Often, pdocs like to know that someone has been to counseling as a way to rule out psychological causes. In that case, it was good that you'd been in therapy for a while.

So it could be more that the process wasn't made clear to you by your therapist early on, or that he truly felt you could resolve your symptoms with therapy.

I agree, I think this is probably what happened. I wish psychological healthcare providers made it clear what their roles are and their methods during the first consultation. But I could just be very naive

It appears more than a little weird that he dismissed your concerns initially by saying you could've googled your symptoms.

In my experience (small, unrepresentative sample etc), therapists do a lot of song-and-dance and hemming and hawing around giving a specific diagnosis. At the same time, they also appear to believe that they need to act "supportive" if clients want to get meds. So, I've found it hard to get a proper read on what they actually think / believe.

I would bring up your concern about the contradiction with the T though -- that sounds like a non-trivial issue for you (regardless of what the "correct" diagnosis is) in terms of just the process of talking stuff over with your T.

I think it's a liability issue--not wanting to appear to be practicing medicine without a license. I find therapists to be chamleon like when it comes to the topic, taking a supportive stance on whatever opinion I expressed, even when it changed over time. I only had one that was adamant about it and said she wouldn't continue to work with me unless I saw a pdoc.

I think diagnoses are ********..

Just my opinion =)

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As others have said, a psychiatrist's job is to prescribe medication--that is what they do. I think it's kind of like the old saying: if your only tool is a hammer, everything looks like a nail.

It seems to me that you should go over this with your T--not necessarily in a confrontational way, but tell him what the psychiatrist said and how you felt about it, ask what his opinion is about whether you need medication or not or at least for some help with your making that decision. Because this is ultimately your decision, and only you know how you feel.

On that note--I was also struck by what you said about therapy being helpful--if it seems like it's working to you, well, maybe it is working well enough, just not quickly. If your symptoms are still pretty severe, though, maybe a course of medication is called for.

That depends on your T's training. Unless he is a clinical psychologist or a psychiatrist he won't have the expertise/training to diagnose.

Psychiatrists are typically the go-to person if someone wants a diagnosis (and meds).

*If* he is a psychiatrist and failed to diagnose you then it's a different matter. Things to bear in mind, diagnoses can be somewhat subjective (or at least not as objective as they claim to be) and/or he lacks the experience of your older psychiatrist.

This would make me feel very angry, dismissed and betrayed. What is that even? WT actual F? He's so smart that he can actually divine your truest motives in spite of how cunningly you've concealed them from him? You said you thought you were depressed and you wanted help. That seems like a perfectly legitimate entire reason to seek therapy. Also: you could have googled the symptoms? I can google the symptoms of TB but still not be sure if I have it. And if I do have it, googling isn't going to make me feel a lot better.

Okay. Perhaps my outrage is over the top but that pisses me right off. I would tell him to google where the sun don't shine and let him know I might come back when he figures out the real reason he's being such an asshole. But that's me.

Oh trust me, I felt the same way. I think if he hadn't said that, I wouldn't feel so weird about the diagnosis from my psychologist. It's kind of hard to trust this process anymore :-\