Being a mental health professional is the best job. As I always tell my medical students, psychiatry is the one field that can consistently create deep and meaningful change in the patients that seek it. However, many people are uncertain about seeking an appointment with a psychiatrist due to myths and misconceptions. Unfortunately, this often delays treatment and, by the time that person comes to finally seek mental health treatment, he/she may be experiencing more severe symptoms. Here we address some frequently asked questions and concerns:
How do I know that what I say is actually going to be kept private?
Confidentiality in all medical fields, especially in psychiatry, is an ethical and legal obligation of your provider. Trust and privacy are the most essential components to any strong doctor-patient relationship, and only once they feel safe in opening up will patients tend to do so. Being open and honest is important, especially because this gives your psychiatrist accurate information about how you’re doing.
HIPAA (Health Insurance Portibility and Accountability Act) is legislation designed to protect the privacy of all patients. HIPAA has guidelines that help providers understand exactly how best to protect patient confidentiality. All physicians can provide you with copies of their HIPAA-compliant privacy practices.
There are some exceptions to confidentiality; your provider can discuss this in more detail with you. However, generally confidentiality can only be broken under three main circumstances: if you are a danger to yourself, you are a danger to someone else or if you sign consents allowing your provider to speak to someone else (i.e. family member or another doctor).
If I see a psychiatrist, am I going to be overmedicated?
“Am I going to be treated like a guinea pig?”
“Am I going to be so drugged up that I won’t be able to function?”
“Will I be taking addictive medications?”
Most psychiatrists aim to be conservative with medication prescriptions; this means fewer medications and lower doses whenever possible. Some, such as myself, opt to use either no medications or just one medication whenever developing treatment plans.
Although medication can be a very powerful tool in achieving your wellness goals, they are never the only treatment option. In fact, the most effective treatment plans typically incorporate several non-medication approaches and techniques, whether or not you opt to take medications in conjunction with them.
Patients who seek outpatient treatment should know that their doctors will provide information regarding treatment options, but the patients must ultimately make the decision about whatever option they think suits them best. This collaborative model will ensure that your concerns are heard and that, ultimately, you will be in control of whatever medication option is chosen.
With conservative dosing, we can typically avoid problems associated with polypharmacy (taking several medications), such as feeling overmedicated or feeling like a zombie. Further, it is ideal to avoid medications with high addiction potentials when possible but, if not possible, low doses and conservative usage is the next best option.
A careful clinical exam, which includes understanding of your family’s mental health history and your own psychiatric history, as well as other techniques (such as pharmacogenetic testing in some cases), can cut down on the trial-and-error of medication prescription. Fortunately, the psychiatrist can use this data to make a more informed decision about what medications to use most effectively.
What’s the deal with seeing a psychiatrist and a separate therapist?
All psychiatrists are trained to be medication prescribers and therapists. However, some psychiatrists do not actively practice therapy or, in some cases, only practice certain forms of therapy. If your psychiatrist is prescribing you medications but cannot provide you the form of therapy that would be the best fit for you, she may recommend that you see a therapist separately.
In ideal circumstances, your psychiatrist and therapist will be in contact with each other regarding your care. There are many reasons why this communication is important, but the primary reason is to make sure that both your providers are aware of how you are doing. This is especially important in cases where you are seeing one of the providers (such as the psychiatrist) with much less frequency.
For example, in a case where a psychiatrist is seeing patient X for medication evaluations on a monthly basis but the therapist is seeing patient X on a weekly basis, the therapist will be able to assess patient’s status more regularly. If the therapist sees that the patient is having a significant medication side effect or has become increasingly depressed, the therapist can then report back to the psychiatrist who may recommend an adjustment to the medications as needed.
I have been told I have a personality disorder. What does this mean?
Many patients present with concerns that they have been diagnosed with a personality disorder. Others have never been diagnosed, but it is clear in our evaluations that they do have personality disordered traits. A personality disorder is a constellation of personality traits that, together, impact functioning and create disordered behaviors.
It is imperative that personality disorders are accurately diagnosed and treated. However, many mental health providers shy away from doing so. Why? Perhaps there is a concern about the stigma surrounding yet another mental health diagnosis. Or it might be due to concerns that the patient may feel the doctor is attacking his/her character.
Personality disorders can be tricky to identify, but the reality is that they often will complicate someone’s clinical picture of depression, anxiety, etc., if not recognized. As I always say to my patients, accurate diagnoses are not for the sake of labeling but rather to gear an appropriate treatment plan. I have tried to be clear about the diagnosis of personality disorder with my patients when I view them as having personality disorders; after all, this is a medical diagnosis similar to the way that diabetes, hypertension and depression are all medical diagnoses.
Fortunately, there are several incredibly effective ways to treatment personality disorders. For example, DBT is highly effective for many personality disorders, such as borderline personality disorder.
Want to know more?
Dr. Aparna Iyer is a board-certified psychiatrist and assistant professor at the University of Texas Southwestern Medical Center. She is a practitioner of holistic and integrative wellness techniques, psychodynamic psychotherapy and of the judicious prescription of psychotropic medications. Her patient population consists of a wide array of people of all ages, both genders and various conditions and ailments. However, her area of interest and predominant focus is in the management of mental illness during pregnancy and postpartum. Dr. Iyer is also a writer and speaker, and she is presently completing her first book on postpartum mental illness.
DISCLAIMER: All information and content in this post are for informational purposes only. The author does not provide any medical advice on the site, and the information should not be so construed or used. Nothing contained in the site is intended to create a physician-patient relationship, to replace the services of a licensed, trained physician or health professional or to be a substitute for medical advice of a physician or trained health professional licensed in your state. The information expressed here are the views of Dr. Iyer only and are not the opinions of any hospitals or academic facilities with which Dr. Iyer has an affiliation. You should consult a physician licensed in your state in all matters relating to your health.