[heygiraffe]

Any chance you could answer some questions? I'll get to them after a couple of (relevant) anecdotes.

I was diagnosed with depression by a psychologist. I got a referral to a psychiatrist, and I was told that the psychiatrist would probably want to do his own assessment of where I was at & what kind of therapy would best benefit me.

Nope. It was, "You've got such & such diagnosis; let's try such & such drug. Bye!" Some years later, I was treated by another psychiatrist. Same deal.

Second, I've read a fair amount about various psychoactive drugs. One thing I've noted in the literature is that often drugs are only found to be effective when used in combination with other kinds of therapy: counseling, etc. So if I am taking a psychoactive drug regularly to treat some condition, then I always get regular counseling for that condition as well.

I have mentioned this practice of mine to both psychiatrists, and both indicated their approval. But in both cases, counseling was never mentioned until I brought it up. I'm thinking that, if I were a psychiatrist, then I might insist that my patients get regular counseling in addition to my treatment. To avoid even recommending it strikes me (in my highly inexpert opinion) as an awful practice, possibly rendering psychiatric treatment ineffective. One might even call it a violation of professional ethics.

So, my questions.

1. Would you say my experiences related above are typical?

2. Would you say that these experiences point out problems (with the two psychiatrists at least, and with the profession as a whole, if the answer to #1 is "yes")?

3. If these are problems, then what do we do about them?

[phren0logy]

1. These experiences are not the norm, but still much too common.

2. Psychiatrists might not recommend talk therapies for a number of reasons (even though they probably should). Many insurance plans don't cover it, and lots of people aren't interested and want a "quick fix" to the problem in the form of a pill. Finally, the education for licensed therapist varies WILDLY, and there are a lot of really bad ones. That can make it hard to recommend in some parts of the country where few/no good therapists are available.

[heygiraffe]

Thanks for the reply.

> Finally, the education for licensed therapist varies WILDLY, and there are a lot of really bad ones.

I hear you there. I had some iffy experiences early on. But a few years ago I found a really good one. He retired, but recommended someone else to me, who also turned out to be really good. I'm seeing him these days.

Maybe what needs to happen is for the norm to be that psychiatrists who see the general public (so not people like you, perhaps) do so in the context of a joint practice that includes various counsellor/therapist types as well. The approach could be that each patient is a client of the practice, with the various specialists contributing their expertise as needed.

(Maybe that already happens a lot. I couldn't say.)

[pm90]

I emphatically agree with your recommendation that more people should seek counseling, even those who lead seemingly happy and/or successful lives. Increased urbanization has unfortunately resulted in less socialization for a lot of people. Especially (at the risk of sounding sexist) for men, who tend to be more introverted. So I see a lot of my male friends struggling with social problems which I think some genuine counseling could really help them with.

We need to remove the stigma attached with seeing a psychiatrist/shrink as something done only by those suffering from mental ailments. And to be honest, I've seen a lot of people turn to self-help "gurus" who just confuse things further by not getting to the root of the problem.

[Yxven]

How does one find a good psychiatrist?

[sosuke]

Personal referrals.

But the real success in treatments now tends to be self education. Not WebMD I mean reading the actual research papers to evaluate what options would work for you. Know yourself.

[pm90]

Unfortunately, it seems to be a lot of trial and error.

[triplesec]

And there's the rub. It's total chance, and there's no guide. You have to understand psychology and psychaitry to have a chance of navigating the system. And when you're struggling, that's the last thing you can do