Blindsided By Diagnosis

[SeaQuel]

I've been seeing my therapist for over a year and a half now. At the onset I explained my concerns about diagnoses, insurances records, and my own personal hang ups associated with such things.

We came to an agreement that she would not diagnose me with anything new without first discussing it with me. There would be no surprises.

Initially I was given the diagnosis of Acute Stress Disorder. This then became PTSD when I met the diagnostic criteria for it (as I recall, ASD is only a short term diagnosis and can be the precursor to PTSD if things can't be resolved). The change in diagnosis had something to do with insurance coverage as well, but mainly it was just about giving me the proper diagnosis. Fair enough. PTSD made sense to me based on my background and it was necessary for insurance.

My therapist assured me that PTSD was sufficient for insurance purposes and that there was no reason for her to add other diagnoses. She said if she ever thought that she needed to, she would consult with me first.

This allowed me to feel like I could be more open with my thoughts without fear that I would be slapped with another diagnosis.

Recently, I asked her for documentation for a career counseling appointment I have coming up. I needed her to provide my diagnosis, treatment, and medications. At the very end of my appointment this week, she read the letter to me aloud to see if I was ok with it before she printed and signed it. The first sentence stated that I met the diagnostic criteria for PTSD and Depression. As soon as she said depression, I couldn't focus on the rest of the letter and had a very strong reaction.

Things got really awkward at that point. I can't even remember the full conversation because I was so upset so I'm sure I will tell this out of order and with gaps.

When she got done reading, I immediately asked her why it said that I had depression. She was totally confused by my question and thought that I knew that all along. She said "wasn't it obvious." No it wasn't f*cking obvious. Not to me. And that wasn't our agreement. She said that it was a package deal with PTSD. That I met the diagnostic criteria for it. She proceeded to list a few symptoms that fit. I explained that while I have had depressive feelings because of my PTSD symptoms, I no longer felt that way and again reminded her that she told me it was all part of the PTSD. I told her I felt completely blindsided.

She apologized for blindsiding me. And quickly just tried to fix it by asking if I wanted her to remove it from the letter. So she did. She assured me it was no where else in my record and had never been provided to my insurance.

We couldn't seem to get back on track after this. I could sense she was really irritated at this point, and I was feeling horribly because it felt like she was mad at me (I can pick up on body language and tone very easily) and because of this major thing being hurled at me. I had planned on thanking her for writing the letter because it meant so much to me that she remembered to do it and had taken the time to support me in that manner. But then when this all went down everything got derailed.

She told she was not mad at me, but was simply frustrated at the situation because she felt a bomb had gone off at the very end of the session, she had her last appointment of the day in 10 minutes, was about to head out of town for a four day weekend, and didn't want to leave things off like this.

We ended with her printing off the letter (without depression listed) so that I could look it over since I had completely shut down when she read it the first time. I thanked her for writing the letter and left. After I read the letter and was able to digest it, I texted her and thanked her again for taking the time and told her I thought it was a good letter. And I apologized for making her frustrated.

She then texted me saying I did not make her feeling anything. It was just that she was frustrated. And that she was glad I liked the letter.

I still feel like shit, I still feel like our relationship has been damaged, my trust in her breached, and confused about my actual diagnosis. Is it possible to have PTSD without having depression? I get that they are often comorbid disorders, but not necessarily a "package deal" as she tried to say. I also have had disordered eating issues, but she didn't give me a diagnosis for that (not that I want one)?

Now I don't feel as though I can be truthful with her about how I'm feeling.

Sorry this was so long, I guess I just needed to get this out.

 

[Ed Norton]

I meet the criteria for depression too, it's from trauma but I got it anyway an because of my pre trauma, history also Generalized anxiety. My T and the team focus on my prevailing symptoms not the diagnosis. Technically, it could be considered malpractice if they don't list everything.

 

[lostforgottensoul]

See this is why i hate labels, of all kinds. It makes people feel "abnormal". Was just discussing labels in another thread is all.

I dont like this:

She said "wasn't it obvious."

First, nothing is "obvious" to a patient, second she went against what you two agreed on. To me, that wouldnt be a good thing for a therapist to say to me.

Have you guys created a lot of trust prior to this?

I agree that you didnt make her feel frustrated, as we cant make someone feel things.

To answer your question i have to use myself, its all i have to go on. Im diagnoised with Borderline Personality Disorder, PTSD, and Generalized Anxiety Disorser. In my case i fit every criteria for depression and suicidal idenation; but its more assumed in my case, not diagnosed so in my case its like a package deal and only diagnosed with generalized anxiety disorder due to have massive amounts of it; more than what comes with PTSD.

But my therapist and i not only talk about it WAY before he writes it in my chart, we also look at the DSM together and doesnt write it until we both agree it fits. So that just seems so off to me. But thats just me.

I think its a per person thing, one may have more depression than another and it seems weird to be not diagnosed with it since i do have depression.

Not sure if this answers your question. Sorry if im not helping or answering your question. Im not sure but to me i think its a per person thing, i dont think everyone fits in a cookie cutter way into everything in a diagnosis.

 

[Ed Norton]

It's possibly a CYA and even if the person just wants to talk to a T for billing purposes a diagnosis is required...everyone who sees a T with insurance will at least have an 'adjustment' disorder...It's just how it works

 

[lostforgottensoul]

everyone who sees a T with insurance will at least have an 'adjustment' disorder...It's just how it works

Thats not true, fully. It depends on the insurence company. My insurence company has a therapist that works for the insurence company that re-ups another year of coverage; which is retarded because United Health Care Beahvioral Health says its unlimited coverage but my therapist and that therapist talk on the phone about me; blah; but the two could talk about how he was counseling two people and their bad marriage and how to communicate or whatever. They cant deny coverage due to not being diagnosed with something, not everyone is.

 

[Ed Norton]

I guess it depends on the policy, many won't cover mental health without something disgnosed. Or will limit sessions. Also, the way malpractice is now, missing a diagnosis is a liability...It's not as bad for mental health professionals but this is a litigious society.

There's a reason so few radiologists want to do breasts, for example

 

[Justmehere]

Different insurance companies have very different rules. You are probably right about the policy. Talking on the phone with the insurance company's therapist and getting on paper authorization are different issues. Also, unlimited session coverage doesn't mean no diagnosis needed. It typically means there is no cap on the number of sessions per year, which some insurances have.

But this all seems besides the point as this is really about your fear that she would diagnose you with something but not tell you about it or talk to you about it before hand - which is what you both agreed upon.

Therapeutic ruptures can happen from time to time. Seeing even an expected diagnosis on paper can be hard. You had an agreement and it makes sense that this has stirred up some strong feelings of distrust for you.

If she put PTSD and depression, rather than major depressive disorder, then it actually sounds like she may have listed the depression as if it was a whole other clinical syndrome but rather a strong part of the PTSD. In that case, the way she listed it, it seems closer to how you actually have seen it all along, as part of the PTSD.

You both actually might more on the same page than it seems like right and even if not, especially if not, all the more reason to go back to her and talk through the feelings and thoughts that this has stirred up for you.

Things might feel really bad right now between you and her, but I hope you don't give up on the relationship. I think this is a chance to actually do good work with her by continuing to go back and work through this. She has been a good therapist to you so far, and she might be feeling frustrated but that happens at times. It's not typically an irreparable matter.

The questions you are asking are good questions and I hope you take them with you to talk to her about in more detail.

 

[hodge]

I agree with all of the above. I've been diagnosed with Major Depressive Disorder in addition to PTSD and it makes sense. All I have to do is look at the damn form I fill out every time I see my psych. It's f*ckng obvious.

It's not unusual to have both at the same time. I, too, feel that it's really part of the PTSD and not something separate. But I guess if they want to separate things out to bill Medicare, what can I do about that?

 

[Friday]

Is it possible to have PTSD without having depression? I get that they are often comorbid disorders, but not necessarily a "package deal" as she tried to say.

I don't know.

I wouldn't have said depression was any part of my first 5year tailspin. Lil bit o' sociopathy, on the other hand? Shrug. Depression has definitely something I've been struggling with this current tailspin, however. Not that I ever know it at the time.

I would suspect that it's possible, as not all sufferers experience all symptoms. But I really don't know / would be interested in finding out.

 

[Ed Norton]

It's hard to not get depressed tbh!

 

[Panda Bear]

For me, the PTSD and depression go together. Tis life....

I've also been slapped with some dissociative something or other....that hurt, truth...but it hurts. T was very gentle In explaining that to me, as I wasn't really pleased with it. I can see why you may have been hurt, but really, it'll be okay In the end. Just talk it through, surprises don't often land well with us folks.

 

[Sandstone]

I don't think PTSD and depression are inevitably linked. I've lost count of the number of times I've said "I'm distressed, not depressed". The Psychologist i currently see agrees that this is the case. She says that when I'm not shut down for protection, I feel the full range of emotions.

Often, what looks like the frozen inaction of depression is actually fear of overwhelm preventing me from acting.

In your position, I'd want to understand what signs of depression she is seeing, and whether she believes it is actually a separate diagnosis