Tag Archives: psychiatrists

Mar 4 2015

Your character sees a psychiatrist

Let’s suppose you don’t want to have you character hospitalized but he needs to see a shrink of some sort. How do you handle this?

First off you need to decide what sort of shrink. Does your character need meds? Let’s say you’ve got a tough guy who can’t see the point of talking about stuff, but his stress level is causing problems on the job. So, he goes to his primary care doc who says: “I don’t prescribe psych meds, but I can send you to a psychiatrist.” Now, if the primary care doc is part of a group, he can make some entries into his computer and the referral is sent. If the doc is on his own, he can make some suggestions. Or Mr. Tough can call his insurance company and see what their procedures are.

So, now Mr. Tough arrives at the psychiatrist’s office. This could easily be quite a while later since demand is high in a lot of places while supply of psychiatrists is low. Nice set-up for some conflict there. “Yes, boss. I’ve got an appointment but the soonest they had was six weeks from now.” What’s a good boss to do?? J.

Mr. Tough finally gets in to see the psychiatrist and checks in with the receptionist who takes insurance cards and has him fill out paperwork, including stuff about privacy. (You don’t really want a discussion about HIPAA, do you? Didn’t think so.) The waiting room is likely to have one or two other people there, or maybe not. Anyway, it’s probably pretty plane with the obligatory magazines scattered on the tables.

Eventually, the psychiatrist comes out and conducts Mr. Tough to the office. Please, do not expect a couch! There will likely be a desk with a couple chairs arranged in front. On the wall, Mr. Tough will likely see the psychiatrist’s diploma. The furnishings are likely to be bland. You never know what someone might find offensive or upsetting. Do not expect Mr. Tough to be sitting in some gorgeous, high-end office. They exist, I’m sure, but in today’s managed care environment, most of us see a doc with rather utilitarian offices. You can add setting details like books and photos. The doc may or may not have a computer on his or her desk. Maybe on a credenza behind the desk.

The initial appointment may last 45 minutes. This allows the doc to get some background and an idea of what’s going on with Mr. Tough. The focus will mostly be on signs and symptoms and any history of mental health problems. This history will include any family history of mental illness since a number of illnesses have strong genetic components. The psychiatrist will then write out a prescription (or several) and suggest that they get together again in a few weeks. Hopefully this will be only a couple weeks so the psychiatrist can check on side effects and well as the impact of the meds on the problem.

Please be aware that many psychotropic meds take a while to “kick in”. This is true particularly of antidepressants.

So, Mr. Tough is given a prescription for antidepressants even though he insists the problem is anger. That happens a lot. The reasoning is that what’s underlying the anger is unhappiness and stress and these meds have been shown to be effective. He may also be given a prescription for something to help him sleep. I’ll discuss some medication issue at a later date since side effects can really give your client some problems to deal with.

When Mr. Tough comes back, the appointment will only be for about 15 minutes and focused on how the meds are doing and any side effects noted. The psychiatrist will, hopefully, be supportive and allow some discussion about the problems in Mr. Tough’s life, but this will be limited. I can’t tell you how many times I’ve had clients come to me, complaining about their psychiatrist’s failure to talk to them about anything other than the meds. It’s just the way things are nowadays in the US. The doctor may or may not change medications around. He’s not likely to refer to a psychologist or social worker.

So, that’s essentially outpatient treatment with a psychiatrist in the US. In a later post I’ll talk about seeing a psychologist on an outpatient basis. As usual, please leave any questions or comments below.

Feb 5 2015

Who’s who is mental health

Psychologist, psychiatrist, LCSW, LFT. Have you decided you need some sort of shrink in your story but have no idea what the differences are? You definitely are not alone! The long-running tv show “Law and Order” often gets it wrong, or at least confused. Here’s a quick, handy guide to help you differentiate the different professions dealing with mental illness.

Psychiatrist

These are medical doctors who have gone through a residency* in psychiatry. Like all medical doctors, they can prescribe medication. In fact, nowadays that’s what they do the most. They do very limited psychotherapy, but do monitor how the medications are working and any side effects. In my years in practice, I often sent a client to a psychiatrist for medications. For a client or patient to see both a psychiatrist and a psychologist is common. Psychiatrists are also the ones who most easily can hospitalize a patient. The issue is whether or not they have admitting privileges at a particular hospital.

Psychiatrists have an MD after their names and are referred to as “Doctor.”

Psychologist

Psychologists have either a Ph.D., PsyD, or EdD in psychology and, if licensed, have passed an examination for licensure. Psychologist perform both therapy and assessment. The use of psychological tests is exclusive to them. Such tests include such instruments as the MMPI (Minnesota Multiphasic Personality Inventory) or (less common nowadays) inkblots. All practitioners do some sort of assessment of a patient, but only psychologists are trained in the interpretation of psychological testing.

Psychologists typically cannot prescribe medications and only occasionally have gotten hospital privileges that allow them to directly admit patients to a hospital.

BTW: EdDs typically work in school settings and are often referred to as school psychologists.

Social Workers

Social workers typically have a master’s degree, though some do progress to a Ph.D. They work in a variety of settings including hospitals and Child Protective Services. They can also have a private practice or work in organizations like the VA. They can provide diagnosis and therapy, often with entire families or couples. They cannot prescribe medications or interpret psychological tests.

Here’s a resource that might be helpful: http://www2.nami.org/Content/ContentGroups/Helpline1/Mental_Health_Professionals_Who_They_Are_and_How_to_Find_One.htm

Feel free to post a comment or question. I’m happy to help.

* A residency is supervised work, usually in a hospital, during which a doctor gains hand-on experience in a particular specialty in medicine.