Should a therapist have done this?

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SD9 has been seeing a psychiatrist for about a year who has diagnosed her with a few things. She has also been seeing various counselors, we keep changing because we never seem to get anywhere, and the latest one seems to disagree with the psychiatrists diagnoses.

I'm not actually certain how much she disagrees with the psychiatrist. I sort of get the impression that they actually agree on the diagnosis they're just calling it different things. She has not made recommendations for med changes though.

 

[Pea-n-Me]

DLgal, what does your husband think?

 

[whatname]

To answer your question, yes, a psychologist, can diagnose clients. In fact, clinical psychologists are trained to do psychological testing to determine or confirm diagnoses. Psychiatrists often refer their clients to psychologists for diagnostic testing/evaluation.

The treating psychologist can give any diagnosis he or she feels is appropriate. The psychologist doesn't have to agree with the psychiatrist and vice versa, although that creates a bit of an issue. Also, psychologists can make recommendations or at least consult with the psychiatrist about medications. Psychologists sometimes make med recommendations to primary care doctors also.

Seeing a client for the first session, I would be hesitant to change the diagnosis, unless I felt it were an emergency. I might tuck the information away in the my mind and see if my suspicions are correct after getting to know the person over time.

 

[tcufrog]

Was it a therapist or psychologist?

 

[DLgal]

DLgal, what does your husband think?

Well, he is one of those people that just shrug and say "okay" to whatever a doctor tells him. He isn't one to research and make informed decisions about his medical care (that's my job, ha ha). However, this alarmed him because he is aware of what the condition would mean to his quality of life and has seen my dad go through it for 20 years. After telling him WHAT he would actually be experiencing if he did, in fact, have this (reading directly from the DSM 5), he was like "oh, no...that's not me at all."

In any event, nothing has changed at this point. He isn't due to see the psychiatrist for another month. He is due to see the therapist next week again and will see if she has any further information after consulting with his doctor. He also plans to tell her that after reading up on the condition, and speaking with me, he is confident that he doesn't have it.

 

[DLgal]

Was it a therapist or psychologist?

See, I'm not entirely sure. He is calling her a therapist. I don't know what her actual credentials are.

 

[DLgal]

@whatname

Thank you for your insight. Your last paragraph is how I would have expected the therapist to approach this.

 

[kiddo76]

My current mental health team consists of a licensed Clinical Psychologist and a Psychiatric Nurse Practitioner. Both providers can and have provided me with initial and updated diagnoses. I appreciate and value both of their perspectives. While my Psychologist might recommend I try a different medication protocol, the ultimate decision lies netween me and my NP.

OP, I think it would be very helpful if you attended sessions with your DH. Some times people with certain types of mental illness may not be capable of reliably transferring information obtained from one source and communicated to another. It sounds like it would be beneficial for you to directly address your concerns with both his psychiatrist and psychologist.

 

[Pea-n-Me]

My current mental health team consists of a licensed Clinical Psychologist and a Psychiatric Nurse Practitioner. Both providers can and have provided me with initial and updated diagnoses. I appreciate and value both of their perspectives. While my Psychologist might recommend I try a different medication protocol, the ultimate decision lies netween me and my NP.

OP, I think it would be very helpful if you attended sessions with your DH. Some times people with certain types of mental illness may not be capable of reliably transferring information obtained from one source and communicated to another. It sounds like it would be beneficial for you to directly address your concerns with both his psychiatrist and psychologist.

I think they are in different countries.

 

[RamblingMad]

Because you disagree with something doesn’t make it wrong. This therapist could be spot on. Or they could be completely wrong.

If you’re really worried, pay out of pocket to see someone in the private sector when he returns. Should be around $250.

 

[LSUmiss]

The explanation is, this was a second session. My husband was trying to get her up to speed with his entire history/situation/reason for being referred to her. He was speaking fast, as he tends to do when he has a lot of information to give someone. It was a 1 hour session and he has a LOT of baggage, for lack of a better word. 40 minutes in, she interrupted him, pulled out a checklist and said "I'm going to ask you a few questions." At the end of the questions, she said "I am going to discuss your current meds with your doctor because I'm sure you actually have (condition)."

He left completely flabbergasted and worried and called me. I don't know what the questions were, but I suspect his rapid fire speech pattern concerned her and he "checked the boxes" enough on the questionnaire. The rapid fire speech is ONE of the symptoms of the defining criteria for this condition, but it is literally just how my husband is. She doesn't know him well enough to know this about him. He literally has none of the other symptoms, and this diagnosis requires several criteria to exist.

Like I said, he had previously been under the care of a different team and neither that doctor or therapist (who he saw weekly for a YEAR) suspected this alternate condition.

In mental health, diagnosing is not an absolute science. I used to tell clients that the official diagnosis is not that important b/c we treat the symptoms. If his symptoms are under control, then the diagnosis really doesn’t matter. However, if they’re not & he has had difficulty getting relief, then, perhaps, it wouldn’t hurt to consider another diagnosis & treatment protocol. If she pulled out a checklist, she may have been basing symptoms on the dsm v criteria for whatever condition she suspected. That’s pretty much how most mental health conditions are diagnosed by a dr or otherwise. Just an example of things that are difficult to detect & often get misdiagnosed...Bipolar II can be a much milder form than Bipolar I which is also why II sometimes gets over diagnosed. More serious psychotic disorders like Schizophrenia are much easier to accurately diagnose although the client is usually much less aware.

 

[LSUmiss]

See, I'm not entirely sure. He is calling her a therapist. I don't know what her actual credentials are.

Credentials matter as far as her ability to diagnose, at least in this state. Here a licensed psychologist,
Licensed clinical Social worker & I think licensed counselors can diagnose.

 

[DLgal]

My current mental health team consists of a licensed Clinical Psychologist and a Psychiatric Nurse Practitioner. Both providers can and have provided me with initial and updated diagnoses. I appreciate and value both of their perspectives. While my Psychologist might recommend I try a different medication protocol, the ultimate decision lies netween me and my NP.

OP, I think it would be very helpful if you attended sessions with your DH. Some times people with certain types of mental illness may not be capable of reliably transferring information obtained from one source and communicated to another. It sounds like it would be beneficial for you to directly address your concerns with both his psychiatrist and psychologist.

I can't. He is overseas without me.

 

[kiddo76]

I can't. He is overseas without me.

I'm sorry, that must be hard. If it is possible for you to speak on the phone with his care team or even email that might be helpful.

My MIL recently had mental health crisis that landed her in the hospital, her 3rd admittance for depression and anxiety. The info she was relaying to DH just didn't add up. Once DH was able to speak with her providers, things became much clearer and he was able to provide them with useful information that helped improve the care she was provided.

Just as an example, When, MIL stopped seeing her psychologist several years ago, she told DH that her Psychologist said she "didn't need therapy anymore" and released her as a patient. Which completely shocked us and made no sense to us. In actuality, the psychologist believed my MIL was not being an active participant in her own care and that their therapy sessions were not being as productive as they could be. So MIL made the choice to drop therapy.

I don't believe MIL purposefully, or even knowingly, lied to/misled DH and FIL. Instead, she developed a false narrative that reinforced her unhealthy thinking.

 

[DLgal]

I'm sorry, that must be hard. If it is possible for you to speak on the phone with his care team or even email that might be helpful.

My MIL recently had mental health crisis that landed her in the hospital, her 3rd admittance for depression and anxiety. The info she was relaying to DH just didn't add up. Once DH was able to speak with her providers, things became much clearer and he was able to provide them with useful information that helped improve the care she was provided.

Just as an example, When, MIL stopped seeing her psychologist several years ago, she told DH that her Psychologist said she "didn't need therapy anymore" and released her as a patient. Which completely shocked us and made no sense to us. In actuality, the psychologist believed my MIL was not being an active participant in her own care and that their therapy sessions were not being as productive as they could be. So MIL made the choice to drop therapy.

I don't believe MIL purposefully, or even knowingly, lied to/misled DH and FIL. Instead, she developed a false narrative that reinforced her unhealthy thinking.

Yeah, my dad has been like this for much of his life. He is so stubborn and is always right, and everyone else is wrong. He went like 10 years without seeing a psychiatrist and having his primary care doctor writing prescriptions for him.

My husband is very much the opposite. He is very proactive in his care for this issue, in terms of seeking it out and going to appointments. He had a 5 month lapse in appropriate care when he first arrived there and finally mentioned it to his boss who called up the chain to the Naval hospital to speak to the Commander there and demand an appointment a.s.a.p. They kept cancelling his appointments on him. It has been such a pain, but now that he has established a care team, they asked HIM how often he wanted therapy sessions and he said once a week at least. His boss is supportive and continuing to make sure the medical team is giving him the appointments he needs.

I told my husband to give the doctor and therapist my email address and tell them they could contact me if they needed any information from me.

 

[Tattylou]

To answer your question, yes, a psychologist, can diagnose clients. In fact, clinical psychologists are trained to do psychological testing to determine or confirm diagnoses. Psychiatrists often refer their clients to psychologists for diagnostic testing/evaluation.

The treating psychologist can give any diagnosis he or she feels is appropriate. The psychologist doesn't have to agree with the psychiatrist and vice versa, although that creates a bit of an issue. Also, psychologists can make recommendations or at least consult with the psychiatrist about medications. Psychologists sometimes make med recommendations to primary care doctors also.

Seeing a client for the first session, I would be hesitant to change the diagnosis, unless I felt it were an emergency. I might tuck the information away in the my mind and see if my suspicions are correct after getting to know the person over time.

In mental health, diagnosing is not an absolute science. I used to tell clients that the official diagnosis is not that important b/c we treat the symptoms. If his symptoms are under control, then the diagnosis really doesn’t matter. However, if they’re not & he has had difficulty getting relief, then, perhaps, it wouldn’t hurt to consider another diagnosis & treatment protocol. If she pulled out a checklist, she may have been basing symptoms on the dsm v criteria for whatever condition she suspected. That’s pretty much how most mental health conditions are diagnosed by a dr or otherwise. Just an example of things that are difficult to detect & often get misdiagnosed...Bipolar II can be a much milder form than Bipolar I which is also why II sometimes gets over diagnosed. More serious psychotic disorders like Schizophrenia are much easier to accurately diagnose although the client is usually much less aware.

Agree with both of these ^^. I'm a masters level licensed mental health counselor in Massachusetts. I can diagnose and 3rd party bill under my license. I probably would not change a diagnosis on a first appt without consulting with the ongoing prescriber. I would tuck it away in my mind though and keep it as a consideration as I worked with the client. It would be considered a "rule out" - a diagnosis that you may suspect, but need further info to be sure.