What Do You Think of This...?

[DaisyFace]

The other day I wrote about the doctor scolding me for not recognizing the results of therapy....and basically telling me we should stop if I don't see that it is working. I was frustrated and wasn't quite sure how to take the doctor's statements.

difficult child had another session yesterday. husband took her so I did not have a chance to speak with doctor--but from what I understand...she told husband that we need to be more patient and trust her methods.

husband asked whether doctor had arrived at a diagnosis yet...

doctor says she believes that difficult child has the following:

ODD
Conduct Disorder
Some kind of attachment problem
A personality disorder

AND

difficult child is "a little bit Bi-Polar".


???????

To me--this means "I have no idea".

What do you think....?

 

[klmno]

Is this a therapist or psychiatrist? I wouldn't put a lot of stake in this but that's just me.

 

[KTMom91]

A "little bit bi-polar"? Like being a "little bit pregnant"?

Personally, I'd like a "little more" clarification on the diagnosis.

 

[Wiped Out]

Frustrating! Hugs.

 

[pepperidge]

I think (among other things!) I would ask how each of the diagnosis defines what kind of therapy the therapist intends to do and if she didn't have that particular diagnosis would the therapy be any different. I suspect that the particulars of the diagnosis don't have any bearing on what the therapist does anyway. It that's as helpful as she is going to be on the diagnosis, I'd tell her for right now you don't think you are getting anywhere on narrowing down the diagnosis and ask why she intends to do for the various issues/behaviors etc that difficult child presents with. Doesn't seem like the diagnosis are going to get you any where useful. What a crock as my kids say.

 

[smallworld]

Is this the same doctor who did testing on your difficult child? How often and for how many weeks/months has she been seeing your difficult child for therapy?

 

[DaisyFace]

Is this the same doctor who did testing on your difficult child? How often and for how many weeks/months has she been seeing your difficult child for therapy?

Yes, this is the same doctor. I believe we are on week #10....

 

[smallworld]

What I think is you need a new doctor.

A psychologist who does THOROUGH testing would not diagnose:

ODD or CD because they are typically products of an underlying disorder (my son had EVERY symptom of ODD and never received the diagnosis because the neuropsychs knew it was a symptom of his other disorders).

An undefined personality disorder because there are many personality disorders so a psychologist should diagnosis ONE, and a 14-year-old would have an EMERGENT personality disorder, not a full-fledged personality disorder because that occurs at age 18

"A little bit bipolar." You either have bipolar disorder or you don't. You can have a mood disorder-not otherwise specified, however.

Are you seeing any benefit from your difficult child seeing this doctor?

 

[ML]

I don't get a good feeling about this doctor. Why would she take it so personally that you don't see results from therapy? I think I would consider a new doctor.

 

[Farmwife]

I have had to learn that not all professionals act professionally. I missed the other post but I am assuming from conversation that we are talking about a psychologist. Although educationally qualified to make diagnosis it doesn't mean the person is good or actually knowledgable in a real life sense.

I have met a lot of professionals who seemed less knowledgable in some mental health issues than I am. 90% of mental health pros. seemed geared toward the simpler issues like post partum blues, troubled marriages etc. etc. Finding someone well versed in difficult child issues is not always so easy. If I get a bad feeling from a service provider I move on. Even if this persons therapy is hlpful in most of her cases if it isn't cut out for your difficult child then it just isn't a good fit.

Yes, good therapy takes time but after paying for 10 sessions I would want to at least be able to see what she is leading up to, you know. Even if difficult child is playing along in her appropriate steps you as a parent should not be expected to "believe in magic". Seriously, there should be a scientifically proven method and not just some feel good talk sessions that have no focus.

Some doctors are not invested in a good patient outcome because it is a loss of income. A psycholgist isn't even a doctor anyway.

Regardless of anything else it is not unreasonable to expect a concise diagnosis with facts to back it up. That should be an industry standard protocol. She should also not get defensive if you ask tough questions. That is your right as a parent. Does she subscribe to Jungian, Freudian or ???? principles? you know? Her process should NOT be a mystical process that you just have to hold your breath to find out. As a parent it is perfectly reasonable to have a clear explanation of her goals, how she hopes to achieve them and yes, how long it takes in the average patient. Most importantly, how many difficult child's has she seen, how many years of experience and what success rates she has had. If she seems to be touchy there is for sure a problem. A REAL professional will and should respect a parent who wants to be informed and involved. Their feelings have zero to do with your difficult child's needs.

 

[Marguerite]

Maybe something to help with perspective here - the Aussie health system now allows a doctor to refer a patient for therapy (with a range of various therapists) with paperwork to allow this to be covered under our national health scheme. For example, my GP has written me up for a Care PLan which allows for me to get physiotherapy, normally something I'd have to pay for myself or cover on my own private insurance (which is a top-off type of cover). But the service is limited - I was only allowed six session of physio under this scheme, after that I have to pay for it myself.

Which means that our country's health system recognises that a short course should bring enough improvement to show if it's worth pursuing further or not.

I would think that ten sessions should definitely be enough to show improvement. difficult child 3's therapist sees him every fortnight, but even if it was every week, that would be ten weeks. I would expect to see a lot of improvement after ten weeks. I certainly wouldn't be happy with the therapist attacking me for daring to question her. Do not forget - SHE is the service provider, not you. SHE has to justify her work to you, not the other way around.

She is right when she says, "If you're not happy, then move on."

But the method of saying, "You are questioning me, therefore you must be a person with a lot of insecurities..." or similar rubbish, it using attack to defend, something I think is inappropriate in this sort of therapist/client's parent relationship.

And Farmwife, I do so agree with you about the way some practitioners (sadly, shrinks especially) tend to use the "You think you don't need me any more, which just proves how sick you really must be" kind of emotional blackmail to force you to stay with them.

Marg

 

[DaisyFace]

Thank you so much for your replies...

You are all echoing my own gut feelings.

I was also under the impression that you had EITHER Oppositional-Defiant-Disorder OR Conduct Disorder because one was a progression of the other. How can difficult child have both simultaneously?

And yes, a "little bit bi-polar"? What??? What in difficult child's history or behaviors indicates bi-polar? And IF she has it, she either has it or she doesn't...not "little bit".

And I don't understand what we are doing at therapy. First, I thought we were still in "testing", since there wasn't a clear diagnosis.
And second--the doctor is taking difficult child's word that "everything is going better"....

Yeah, right. Where I live--things are still the same. I have seen a difference in difficult child's mood since adding Abilify--but other than that....things are the same. So I am thoroughly confused.

And it would be easier to just get a new doctor if I felt like I had a lot of choices. This doctor is at the university and it took an awful lot of wrangling just to be able to get an appointment with her.

Maybe I will try and get her to pin down a few solid goals or benchmarks that therapy is supposed to achieve....