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Emdr Or Cbt?

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SarahD

Learning
My psychiatrist is leaving his practice and going somewhere I can't follow him. I have only had a four or so meetings with him and none of the meds I am on were prescribed by him, so I am not heartbroken over this. I have narrowed down an extensive search to a psychiatrist who does CBT or a therapist who does EMDR. The psychiatrist has the benefit of a high quality mental hospital and support care.

I have PTSD due to a tramatic pregnancy and experience anxiety at the slightest hint of nausea or a hot flash, the latter of which now leads quickly to suicide ideation. I am terrified to eat and since I had a breakdown this week I am stuck between being nauseated and starved. This is starting to cause a lot of physical/emotional distress...

I have noticed quite a few people here have had success with EMDR. Just looking for feedback, suggestions...
 
Hi Sarah,

Will it be either a psychiatrist or a therapist? Personally I would only go to a psychiatrist for med management or diagnoses. I would definitely see a therapist to actually get treatment. And I would definitely see a therapist (whether they are psychologist, counsellor or counselling psychiatrist) that specialises in and has understanding of trauma.

Whether that treatment is more talk based exposure or EMDR is something that I think might be different for different people and where they presently are.

Good luck deciding!
 
It's kinda a matter of cost. The therapist I have seen for the past two years only charges $20 a session. He specializes in PTSD and offers this program for residents to sit in on his sessions. He does not do EMDR and I don't feel we are making any new progress, although I really connected with him and feel safe with him. I will research the insurance issue more and see if we can find a way to go to both. Money seems to just add another level of stress to an already precarious situation.
 
If it was me, one thing I'd be looking at is how long they've been qualified and how much experience they have working with PTSD/trauma (what percentage of their practice, and how long for). For the EMDR therapist, I'd also consider the level to which they're trained in EMDR and how recently they completed their training.

Like Abstract, I personally would see a therapist rather than a psychiatrist (except for diagnosis). I know some people like to see a psychiatrist, though, and it's very much a matter of what you want.

Is it possible to have a trial session with each, to see if you like their style and what they say about their approach?
 
The psychiatrist has the benefit of a high quality mental hospital and support care.

I have PTSD due to a tramatic pregnancy and experience anxiety at the slightest hint of nausea or a hot flash, the latter of which now leads quickly to suicide ideation. I am terrified to eat and since I had a breakdown this week I am stuck between being nauseated and starved.
Does the psychiatrist do therapy and treatment? I see a psychiatrist who is better than any therapist or psychologist I have seen in the past. So it does depend on what each individual offers. Can you do a session with each person and explore what is on offer?

If suicidal ideation (SI) is an issue and the psychiatrist has quality hospital care and ongoing support perhaps go that way for a year and reassess?

You need someone who can address the SI immediately and help you become unstuck from being nauseated and starved.

Good luck!
 
My friend who recommended the psychiatrist said she mainly just adjusted meds. A therpist friend of mine said she has experience with PTSD and is good. I am tempted to go with a therapist and work with my primary on the meds. Just this past week he mentioned the hot flashes may be adrenal instead of hormonal and there are meds we can use to treat that. Removing the hot flashes would remove the suicide ideation and let me concentrate on therapy for the actual trauma... Just putting my thoughts down... Please feel free to add suggestions--you all have been very helpful. I've only been on the site for 1 day and already feel like I am not alone.
 
My friend who recommended the psychiatrist said she mainly just adjusted meds. A therpist friend of mine said she has experience with PTSD and is good.

Sorry, I'm a bit confused. How does the CBT fit in with this? Was your therapist friend talking about the psychiatrist, and if so in what way does the psychiatrist have PTSD experience and is good... with the meds?

I'd be wary of relying too much on other people's recommendations. They're great to have as a starting point, but my suggestion would be that once you've got a shortlist of people to see, then it needs to be your own research and your own views. Other people may be coming from a different place from you with regard to therapy/psychiatry. Your individual situation, history and personality might mean your interaction with a therapist/psychiatrist isn't the same as another person's, or even most of their clients'.

I was referred to a psychiatrist who's extremely well thought of by many clients and other professionals. He's written popular books and academic research articles, and there are people who say he "saved their life" etc. It was the worst therapy experience I've ever had. I think you really need to research and talk to the practitioners yourself to make a decision.
 
Sarah,

I am now not sure if I may have misunderstood your situation so please feel free to correct me.

It seems you have been seeing a therapist (counsellor?) for 2 years who specialises in PTSD. And then you either left that therapist for a psychiatrist or you simultaneously saw a psychiatrist who is leaving after you saw him just 4 times.

What were you seeing the psychiatrist for and was he doing counselling with you or adjusting your meds? It seems you are still seeing the therapist but are not happy as you feel stuck?

Is your real dilemma here that you are considering EMDR rather than the trauma talk therapy that you are presently doing? What has your last 2 years treatment entailed? Have you directly discussed the trauma itself?

Or is it that you were thinking of leaving your T for a psychiatrist? Or a different therapist? Or a different type of treatment?

I believe some psychiatrists do do counselling and if that is their interest and inclination can be very good at it. Maybe it again depends on what the person does and is experienced in and what suits you as an individual.

I agree with Hashi that looking at how much of their business is trauma/PTSD related is a good idea. Some seem to list everything and the kitchen sink as their speciality. And I do also think experience is very helpful.

who is better
:tup: Miss Spock! So glad for you. :)

PS. I never saw the last two post when I wrote this Sarah but look forward to hearing more if you feel able to share.
 
I am so sorry for the confusion. Two years ago I was diagnosed with PTSD. My primary doc controlled my meds and I began seeing a therapist. After awhile things seemed to work themselves out and after 18 months I was off the meds and out of therapy. That lasted about two months before I relapsed, with a venegence. My primary decided at that point to send me to a psychiatrist to better control my meds and I went back into therapy. Then I ended up inpatient just before Christmas and most of my medications were set while in the hospital. (This is also when I got my OCD diagnosis.)

Now my psychiatrist is leaving and I am looking for a new one. Only in doing some research, which led me here, I also read about biofeedback and EMDR. So I began looking for therapists who did EMDR, since that seems to be very beneficial and something I haven't tried. The SI is new, only since Dec.

While a therapist friend of mine told me about a 'very good' psychiatrist with experience in PTSD, a different friend who goes to her, and likes her, said her sessions are very brief and usually are just about adjusting her meds. The website for this psychiatrist seems to promote CBT, but my friend said she had to go to a therapist in the same practice for therapy. I was confused on all of that myself until just a couple of hours ago.

I like my therapist, but we have done mainly relaxation exercises, mindfulness, and focusing on changing thought patterns. And I just feel stuck. Since my triggers are mainly phsyical, I have a hard time telling myself everything will be okay during an hour long hot flash or persistent nausea. Relaxation rarely works to shut down these arousal systems.

So...I am wondering if I need a psychiatrist, or just go back to my primary. And I am looking into finding a new therapist with new treatments.

Did that help, or is it more confusing?:confused:
 
I was told that EMDR is good for single traumas but has to be done cautiously for those who have suffered multiple traumas. I have suffered multiple traumas and at this point have been told I am not a good candidate for EMDR. My therapist does EMDR and I have been seeing her almost 2 years. She told me I need to be able to feel safe and that I am not ready for that yet. You may want to find out first whether or not you are a good candidate. If you suffered PTSD from a single incident then you probably are but you should make sure first that you are a good candidate and find out what the credentials your EMDR therapist has as well.

Good luck and I hope you are able to get the supports you need.
 
That helped thanks Sarah!

It seems you have had skills training and cognitive behaviour therapy (CBT) and have had meds but have not actually processed the past trauma in therapy. ?

It also sounds like the new psychiatrist is not a counselling psychiatrist and that he rather gets therapists in the practice to do therapy.

The way I look at it the medication is another form of coping (along with coping skills and better thinking skills) but dealing with the trauma in therapy is the centre of what recovery is about for me.

Dealing with the trauma is often called exposure therapy and as I understand it there are different ways to have exposure therapy. They include EMDR, EFT and talking through it.

It also seems it would be important for the therapist to re-evaluate your coping before embarking on something like that as you are already struggling with suicidal ideation and you need to be able to stay safe through it. And getting the correct meds could help that too.

There is no way we can alleviate triggers from our lives (even if you improve your physical issues now you may have others that are triggering for you later) but by dealing with the trauma we can take the power out of the trigger.

It sounds like a better idea to find a psychiatrist who specialises in PTSD/trauma to re evaluate your meds rather than going to your dr in my opinion.

If your therapist has never discussed the intention of dealing with your trauma directly when he feels you have enough coping skills then it may be worthwhile considering changing. Have you discussed your feelings with him? I do think its good that he has worked on providing you with skills rather than just trying to do trauma work without them as that often seems to happen. EMDR or any exposure therapy without that would be very difficult I am sure.

And if you do decide on EMDR it seems it is extremely important to get someone that is very knowledgeable and experienced as having it done without the correct preparation and follow up as well as administration can be dangerous. When done well it seems to help people very much and many swear by it.
 
Hi Sarah,

Thanks for clarifying. It doesn't sound like the psychiatrist is still much of an option for you, given the additional information - at least not on their own. Is that right?

Can only repeat from the above posts - I think check out the EMDR therapist, and talk to them. I've had a trial EMDR session "working" on something completely non-traumatic, just so that I could understand what the process felt like. That told me it wasn't for me, but it was good to have tried and find that out.

Very much agree with Abstract about the need to process the trauma, but to have coping skills in place first.

I'm kind of hesitant to throw yet another thing into the mix for you, but have you considered a somatic therapy? Either somatic experiencing or craniosacral therapy (with someone who knows what they're doing with trauma - and not just birth trauma)? Everything you say makes me think about it. It sounds like you have a high level of somatic (physical) symptoms. Somatic therapy works with the central nervous system to release the trauma that's still held in the cell tissue, either suppressed and causing issues as a result of that, or emerging as mental/emotional/physical symptoms and body memories.

Somatic experiencing consists of talking and thinking about what happened in order to "rewrite" it and therefore release the held trauma. With craniosacral therapy you don't have to talk about or even think about it during the treatment, although things can come up physically, mentally and emotionally around it and I would recommend seeing a trauma psychotherapist alongside it. It may not be for you, it's only a thought. If you were interested, all the usual cautions would apply - check out therapist credentials, membership of a regulating body and experience with adult trauma.

Whatever and whoever you're considering, I think find out all you can about them and be willing to have a trial session as part of your research.
 
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