Something that has been bothering me

[DammitJanet]

I havent said anything before about this but I have finally decided to take the bull by the horns and post.

I keep seeing people reply to people on the board about how certain types of people are the only ones who can diagnose people. Especially it is said that psychologists and social workers and therapists cannot diagnose and only psychiatrists can diagnose. Well that is not true in all states.

In NC a Licensed Clinical Therapist or a Licensed Master Social Worker is the one who does the assessing and the preliminary diagnosing. These are both either PhD or Masters degreed people.

Im sure in some states it is the Psychologists who do the diagnosis. Actually to work in most hospitals, health departments or clinics a psychologist would have to have at least a Masters degree and be working on his PhD. While working on that PhD he would be supervised.

I dont think we can just make a blanket statement that only one specialty can diagnose. It does differ by state.

Ok...just my opinion.

 

[kris]

<span style='font-size: 14pt'> <span style='font-family: Georgia'> <span style="color: #3333FF"> it's the same here in florida & also in jersey. when i was suffering a major depressive episode the psychologist...a Ph.D...diagnosis'd me & the ins co authorized payments to him.

kris </span> </span> </span>

 

[DDD]

I may be one of the guilty parties, Janet. Over the years I have
been exposed to many Psychologists/Therapists with no advanced
education regardless of their intention. Usually I try to avoid
the subject altogether but, as happened very recently, when a new
person has a child with suicidal ideations I panic for them and
try to direct them to the highlest level on the chain.

When GFGmom was 5 I finally talked my then husband into going with me
to the University where we had an appointment with the head of the psychology department. (Remember, I was still a young thing
and had no idea that I would end up a Warrior Mom!) This man had
a PHD and after an hour with the three of us suggested "perhaps
it would be best if you found a residential placement for her and
just moved on with your life". ( My husband thought that was a
great idea.

Eventually I found some help from qualified people.

When you are young and your life has gone to He__ in a handbasket
I think it is a good thing that people redirect you to seek help
from others "if" you don't feel really comfortable. DDD

 

[DammitJanet]

I think it makes a huge difference on the state.

It used to be that ANYONE could hang a shingle out and call themselves a therapist. They didnt have to have a degree in anything. Then you got people with a bachelors in psychology who were considered to be psychologists...uhhhh NOT!

In todays world...at least in NC...they have to be so degreed its pathetic. My therapist is a PhD and she is simply a Licensed therapist but she is the one who does the assessing and the diagnosing. Before she got her PhD she was a MSW.

 

[smallworld]

Janet, guilty as charged.

We have been to many, many mental health professionals with our 3 kids over the last 5 years. A PhD psychologist missed depression in difficult child 1. So did a developmental pediatrician. He also didn't understand the significance of a prolonged intense manic reaction to an SSRI and wrote it off as oppositional behavior and emotional reactivity. It was only when difficult child 1 had a psychiatric evaluation that we understood the significance of what had occurred and got him the proper treatment (mood stabilizers). A licensed counselor missed a psychotic reaction to an SSRI in difficult child 2 (even with me telling her over and over what difficult child 2 was doing and saying). Another PhD psychologist tried to do behavior mod with easy child to get her to eat when she developed her choking phobia. It was only when we got to a psychiatrist who specializes in feeding disorders that easy child was able to make any progress at all. These "bad" professionals were all highly recommended by other doctors and highly regarded in their fields. They just had very little of the right experience to help my kids.

It really bothers me when a new poster comes on to the board and says a psychologist diagnosed her 5-year-old with ODD or CD (and nothing else). Or a social worker categorizes extreme agression and violence as ADHD. In almost every case, there is some other underlying disorder driving the behavior. I know I'm generalizing here, but a lot of psychologists tend to look at the behavior and not the underlying cause fueling it. It has been my experience -- and many others on the board -- that when you treat the underlying disorder, the behavior improves.

I actually don't know what the law is in Maryland, and I don't really care. Based on my experiences with my kids, I personally would only go to a child/adolescent psychiatrist to diagnosis and treat mood issues (anxiety, depression, bipolar, etc). I would only go to a neuropsychologist to diagnosis ADHD, autism spectrum disorders and learning disabilities. I would go to a psychologist for academic testing, period. I would consider using a licensed social worker for therapy once the diagnosis is known.

My point in relating all of this is to tell you why I strongly recommend certain professionals to diagnosis certain disorders. I think you can easily go down the wrong path and make very little progress with professionals that are not suited for the job.

 

[Marguerite]

It's different for us in Australia, too, and I am often aware of the differences especially in how health care works.
While I do have respect for psychologists, especially those who keep up with their training and make an effort, I've seen some duds. I've also seen some duds in psychiatry. For us, nobody can call themselves a psychologist unless they have a degree in psychology, and our health care system requires some level of professional registration which requires further accreditation. But we still have people calling themselves "therapist" when they may have only done a weekend workshop (if that).
Our psychiatrists are qualified doctors first, then they do further study and specialisation. But the filed has changed and developed in recent years, and some who practice are not up to date.

One thing we have found - to always be prepared to keep an open mind re diagnosis. Different people have different ideas. With autism, we need several specialists to have input. The most important for us are the speech pathologist and the psychologist. A pediatrician can replace the psycholoigst.

Marg

 

[kris]

<span style='font-size: 14pt'> <span style='font-family: Georgia'> <span style="color: #3333FF"> [ia person cannot call themselves a therapist (a person with-a master's degree either in psychiatry or psychiatric social work) or a psychologist with-o at least a master's degree. how adept they are at diagnosing is a separate issue. just because they can diagnosis doesn't mean they should. &lt;sigh&gt; then again there are psychiatrists (MD's with-a residency &/or fellowship & has passed the psychiatric medical boards) who shouldn't be dxing either.

it's all about compentancy.

kris [/i] </span> </span> </span>

 

[DammitJanet]

Very true Kris.

I trust my therapist implicitly. She has a far greater understanding of psychiatric disorders AND medications than the idiotic psychiatrists who stagnate in the state jobs they have at county mental health. The psychiatrists are old and ready for retirement. Dismal and hopelessly out of date.

 

[Sue C]

I THINK in Wisconsin a psychiatrist has to make diagnoses, but I'm not certain. A psychiatrist diagnosed Angela and Melissa with ODD. But I think it may have been a social worker with a masters degree who diagnosed Melissa with mild ADD.

Oh.........and husband & I have now diagnosed Melissa ourselves as having borderline personality disorder (seeing how we won't be able to get her to go see a psychiatrist).

Sue

 

[kris]

<span style='font-size: 14pt'> <span style='font-family: Georgia'> <span style="color: #3333FF"> i do believe that every mental health professional has to be lisense in order to practice. that makes them qualified to diagnosis.

kris </span> </span> </span>

 

[Hound dog]

I'm probably guilty too.

I've had psychiatrists tell me that without an MD psychologists and therapists aren't allowed to diagnosis. I'm not sure what our state's requirements are as far as education, but I've gotten many tdocs with just an associate's degree. Actually, I think all but one that N saw had their assoc degree. The thought of them dxing makes me shudder.

Although the therapist/psychologist N had in Dayton was going for her Phd, plus had many years in the field experience. She gave N the preliminary diagnosis of bipolar/borderline. psychiatrist backed her up. She and psychiatrist worked together that way.

Here it seems therapist and psychologist are used interchangably, at least in my experience. The education level can be drastically different. You can have someone with just enough to hang that shingle out, or you can have someone who can diagnosis and have it confirmed by a psychiatrist.

I worry about inexperienced parents accepting a diagnosis and treatment plan by someone who may not be qualified to give it. (N and T have both run into this situation) I'd rather have a parent error on the side of more experience/education.

However, I think I'll be asking N's psychiatrist this when we see her next friday. I'm glad you brought this up. I'd like to be sure of ohio's licensing guidelines. It's a good question that probably all parent's should ask.

 

[DDD]

Two more thoughts on this subject...lol.

Alot of the newbies have kids who are diagnosis'd with ADHD by their
Pediatricians. As a result their kids have reactions to medications
and they think their kids are devil spawn or that they are lousy
parents. Around here the Pediatricians actually include in their
yellow page ads "we treat ADHD". Good Grief! So delays and bad
pattern setting lead to worse issues.

Secondly, the Psychologists can't prescribe medication or monitor
it. So...if you get a diagnosis...you still have to find an MD to write
the Rx and, more importantly, help get to the right balance. I
have had over forty years many lousy Psychologists (with multiple
degrees) and ONE totally outstanding one who basically made it
possible for GFGmom to end up "kinda" normal..lol.

I have had a horrid Psychiatrist, you all may remember, who
actually told difficult child to sit still and asked him "do you realize I
could Baker Act you?" Yep, he still practices here.

It's the luck of the draw but I prefer to start at the top of the
chain. DDD

 

[DammitJanet]

I think a lot has to do also with a parents insurance situation. If one is lucky enough to have private insurance you can access "top of the chain" more easily. Medicaid may make that harder initially. Also location plays a part. And if a parent has no insurance...well...then they are really stuck in using what is available.

Where I live there are few psychiatrists in private practice in my town. I had to go to the next larger city to get a really good one who I loved and will return to when I get insurance back.

 

[jbrain]

Hi,
my difficult child 2's therapist (who is a social worker) came up with her diagnosis but only after seeing her for nearly 2 years. He and she came up with it together--dissociative disorder. Her psychiatrist thought she was ADHD, had Obsessive Compulsive Disorder (OCD), suffering from depression...she certainly had symptoms compatible with those conditions. Her therapist, on the other hand, wasn't diagnosing her with anything--he had to wait til she trusted him enough to completely open up with what was going on. It all makes sense now--the ADHD, Obsessive Compulsive Disorder (OCD) and depression symptoms are due to the underlying disorder. She is making a lot of progress now that everyone understands this. I don't blame the psychiatrist for diagnosing her with the other disorders and trying medications for those--difficult child 2 was only seeing her occasionally and mostly just for the medications. I am thankful she has a patient, wise therapist who has been openminded and not set on a particular diagnosis--waiting for her to trust him enough to open up.
Jane

 

[DazedandConfused]

Well, I know I have done that. It may very well have a lot to do with insurance. Because, my experience has always been "we need a medical diagnoses by an MD". I've been having a hard time with Ins getting Occupational Therapist (OT) for son because they need a "medical" diagnoses from an MD. It was the same when I wanted private speech therapy for Daughter when she was three and needed Ins to pay for it. I had to get a diagnoses from her Oncologist before they would authorize it. Of course, she relied heavily on the evaluation done by the speech therapist. Which I think many MDs do anyway in these types of situations.

Having an MD doesn't necessarily make that individual knowledgable in the area diagnosed. I know that had I been getting medical guidance from my difficult children pediatrician for their various psychological issues, I would have never have gotten as far as I have now. On our last visit about a month ago, he dismissed the idea that I should take Son to a neurologist due to some concerns that I have. I thanked him for his opinion and took Son to see one anyway (thank goodness I have a PPO and not an HMO) and I'm so glad I did. The pediatrician is good for basic medical care, but anything beyond that I do not bother with him anymore.

Actually, Janet, I'm glad you took the bull by the horns. Though, if somebody needs medications, they certainly need to have an MD on board to be able to get the scrips. It's that way in Ca, anyway.

I know that husband sees the NP instead of the MD when he goes to the doctor. She's actually more thorough than the Dr and husband trusts her judgement because of it. Though, I am also concerned when newbies post that they have never had any medical testing and a therapist has made a diagnosis. This is a good topic and I will be more careful in my responses regarding diagnosis. There are so many variables in our experiences. I will take that into consideration when I respond.

 

[hearts and roses]

A counselor I initially sought to help me parent difficult child 'better' is the one who diagnosed her waaaaay back. The neuro-psychiatrist we saw about 3 years later at her urging was able to prescribe difficult child's first medications which made a huge difference. It was wonderful to work with both.

 

[DammitJanet]

I hope I didnt step on any toes but it just got me to thinking that some parents may be thinking that they are doing something "wrong" if they are using what is available in their area.

Way back when Cory was just a little guy he was seen by more different specialties than I can shake a stick at. He was very complex. Back then they didnt diagnose bipolar in kids very often, at least down here. He got the ADHD and ODD diagnosis. The doctors were all stymied because he didnt respond how he should have to medications or therapy. I had one of his therapists who took me aside and told me that if she didnt know better she would swear he was bipolar. He was 7. She also told me I would never get a doctor to diagnosis him with it until he was older. She was right. Everyone kept shaking their heads and telling me that there was "something else" going on with him but they werent sure what it was. I think they suspected but since it wasnt in the DSM they were flummoxed.

 

[timer lady]

I've had many clinical SW & psychology students work in my home. The tide is changing ..... they are being trained to do the evaluations & initial diagnosis's & pass this information onto psychiatrist.

While our psychiatrist has made every diagnosis the tweedles carry it is backed up by evaluations completed by members of the team here.

Janet, I'm glad that you brought this up. However, I'd like to add that it seems to be an effort of many professionals. Many times a psychiatrist has to be brought into & needs to confirm diagnosis's in order to prescribe medications that are their expertise.

Thanks for the thought provoking thread Janet.

 

[lordhelpme]

i'm glad this was brought up cuz in my limited but growing experience of going the private and now public health route, an msw can make an inital diagnosis but the psychiatrist makes a formal diagnosis based on msw experience with-the child and their info.

in the private sector the psychiatrist could careless to talk to us except to give us a new rx. in the public sector now we have a 1 1/2 hour appointment this friday where the psychiatrist spends time with-us and difficult child.

sometimes it is not so much about the letters after the name but the experience and diligence of the person the name represents!

 

[wakeupcall]

In the area of Texas that I live in, none of the child psychiatrists make a diagnosis or do testing. All they do is manage medications. There are some child psychologists who test and do therapy and others who do no testing whatsoever, just talk therapy. I find it very difficult to balance it all and feel a little un-nerved at having to try to explain the diagnosis to the medication doctor what I think the problem is. I've found very little difference in the state and we've lived in several places.