Conflicting Advice In Therapy

[Mr Tonks]

Hi all

I am new to this forum. My husband has PTSD, I think on this site you would call it CPTSD as a result of child abuse from his father.

He attended his first counselling session with a new counsellor on Monday he is also currently seeing a Psychiatrist and a Community Psychiatric Nurse. They have him on 225mg of Venlafaxine XL and Seroquil 50mg at night.

The counsellor told him on Monday that he shouldn't be taking medication. My husband finds it very difficult to trust anyone and then for the medical experts to add to this has made him worse.

He is currently very suicidal and I dont know what to do to help. My husband is on a waiting list to see a Psychologist but the counsellor said that this could end up doing more harm than good.

We have been dealing with this for about 2 years now and it just seems we keep hitting brick walls and I dont know what to do anymore. I have taken time off work as he cant be left on his own.

Suppose my question is who do you believe, what is the best way forward?

Any advise greatfully received.

 

[intothelight]

Hi Mr. Tonks,

The first thing I would do is find out why the counselor does not think your husband should be on medication. Was their something in his behavior that prompted this opinion, or is this just their viewpoint on medication? At any rate, whenever mental health professionals have differing opinions, it is good to clarify.

It is good that your husband has someone looking out for him.

Take care.
Debbie

 

[anthony]

Typical doctors, straight to drugs. An SNRI and anti-psychotic... I agree with your counsellor, as the research from experts on PTSD go against the anti-depressant first line treatment protocol now for PTSD, instead opting at only targeting the anxiety itself, often deflating / removing the depression, being mood based, not chemical based.

Most anti-depressants make you more depressed, and that is the warning on anti-depressants. I would be demanding more something that targets ONLY the anxiety, not an SSRI or SNRI, that is an anti-depressant, that the companies CLAIM works as effectively for anxiety as well. Not the solution. You want an anxiety only treatment, ie. diazepam (valium) or such direct drugs in low dosage, multiple time daily, to treat only the anxiety. There are a few options that you physician can talk with you about.

Your counsellor is spot on though, and psychiatrists are usually lazy and obtaining kickbacks by treating first with medication, especially anti-depressants... and especially since all the latest research data indicates from US experts on PTSD what I have stated above.

 

[ronin47]

It would be good though if the counselor said exactly why he/she thought your hubby should not be on meds. An increase in suicidality is a very real side effect that your husband could be dealing with.
I'll be honest, just the name "Community Psychiatric Nurse" makes me apprehensive. That sounds exactly like the type of person who would view medications as the solution rather than a tool. Take their supposed medical expertise with a grain of salt. The first psychaitrist I saw talked to me for all of maybe 15 minutes and then diagnosed me with three things and perscribed me 3 different medications without discussing with me any of the possible side effects.

I had to find out on my own months later that the Risperidal was responsible for the 20 pounds that I gained (after which I decided 'Well screw this' and stopped taking them).

It turns out all of the diagnosis he gave me were symptoms of my PTSD and consequently all of the medications were useless.

About a year later I met with another psychaitrist who spent two half hour sessions with me, didn't diagnos me with anything to speak of, and perscribed me one medication that helped me tremendously. We worked together for almost a year before we finally settled on the right dose for me.

I would definately go with your counselor on this one. Find a different psychaitrist if you can. If it were me I'd go ahead with seeing the psychologist. Use your common sense whenever a mental health professional gives you advice of any kind and ask yourself, "How well has this person really gotten to know me/my husband?"

 

[Lucycat]

I take Seroquel 50mg at night, and would not be without it ( I have CPTSD). It was recommended by my CPN and approved by the psychiatrist, prescribed by the GP. It is used in these low doses to treat anxiety and is very effective. It also aids sleep and reduces nightmares/dreams. I also found that I lost weight - not gained it.

Prior to the Seroquel I had valium/temazepam for 2 weeks prescribed by my GP ( before I had seen the CPN) It was awful - I was like a zombie, but still not sleeping or even able to function at anything. It was such a relief to find the Seroquel - for me it is something that really works and has helped me no end. I am permitted to take an extra dose during the day if anxiety raises its ugly head, but these days don't need to any more.

My CPN is my Therapist - does the counselling/ EMDR everything.

I don't go with the 'no drugs' advice. Therapy is certainly what will make you better but medication to help with the symptoms helps to get through the therapy.

I agree with the advice above - ask the professionals, and best of all get all 3 to talk to each other!

I wish your husband well.
Lucy x

 

[Artfulone]

Dear Mr Tonks,

Personally I haven't really taken much medication, a few months of Citalopram which didn't even touch the sides. I was offered Seroquel Quitiapine after a short and poor meeting with the most qualified psychiatrist in my area and his underdog. I viewed their advice as poor to very poor as they did not consult me, discuss what they intended to target and they thought I had symptoms of Anti Social Personality Disorder (I have done counselling training and look down upon system centred psychiatrists). I clearly have CPTSD with severe dissociation as confirmed privately.

The difficulty with anti-psychotics is that they can encourage internalisation and simple dulling of symptoms and cut one off from the feelings that one is gradually working on bringing out and processing in therapy. Many therapists see the drug free or minimal drug model as best. The Royal College of Psychiatrists in the UK actually recommends anti-psychotics and anti-depressants for PTSD/ CPTSD along with specialist therapy.

A lot of it is about personal choice. Personally I would have used drugs for longer if I was allowed to make an informed and educated decision based upon and tailored to my symptoms and needs with careful monitoring, but that wasn't on offer.....only the system centred model with very little client input and no client choice was on offer. So I ditched the psychiatric drug approach. It is up to you and your husband to see what works for your husband. Everyone is individual and has different needs at different times. Lots of people use the psychiatrists medicine to good effect, but without therapy it is often little more than a panacea even when properly directed.

Trauma therapy takes a long time to really take effect and there are seldom any magic solutions- just gradual ones. For me it really is working but I will be honest and say that it took three to four years to even encounter sub- clinical levels of trauma rather than clinical levels. Now at six years I really can feel the effect and whilst I keep getting clinical level symptoms regularly they don't stay very long normally and they are becoming much more managable. I can see the light at the end of my tunnel, even though it still may be three to five years away.

 

[Srain]

I agree with Lucy. Without the ability to sleep, which in my case is vital, I would in the hospital over medicated and out of it. Getting the team is key, no doubt but be aware that each person is different, what works for one of us doesn't necessarily work for the other.

I am all for Trauma Therapy, after literally years and years of therapy, my new therapist is a specialist and immediately there is progress. However, maybe in the beginning your loved one needs not only a good therapist but a good dr to help him where he is at right at this moment.Good luck.

peace,
Rain

 

[Glenys]

The counsellor told him on Monday that he shouldn't be taking medication. My husband finds it very difficult to trust anyone and then for the medical experts to add to this has made him worse.

My first reaction was one of shock that a counsellor, who is NOT a medical professional, should tell your husband he should not be on medication. There is also the question of whether he should be seeing a counsellor and if that counsellor is in communication with his psychiatrist and CPN as part of a multi-disciplinary team? It would seem your husband's counsellor has an extremely high opinion of his/her own limited knowledge and expertise.

Best way forward? Get shut of this counsellor and make a referral of their attitudes to their regulatory body - if they are registered with anyone.