I don't think my therapist listens 😕

[BrokenHalo91x]

I have been seeing my psy for around 3 months.

I was referred to there by my employer, after having a massive emotional flashback
(I didn't know what this was at that point)

I was sent there due to the 'Reaction' I had to an 'event'

Anyway, my first appointment with my clin psy, they knew why I was there cause my work had made the referral. I am in a job where I am exposed to traumatic events frequently. They ultimately said that I had experienced an emotional flashback, and said it's likely PTSD.

my second app my psy started quizzing me about my childhood, long story short, he said likely Complex ptsd.


And since then, he has said that he doesn't believe in diagnoses, that I probably wouldn't meet the criteria for cptsd, because I don't have Re-experiencing symptoms??


I have every symptom on the list.


What symtpoms do you guys and girls suffer with on a daily basis and also when triggered?.

I'm just frustrated I guess.

 

[Weemie]

Ask him why he is working as a clinical psychologist if he "doesn't believe in diagnosis." How does he do insurance paperwork? You have to write something. You can't just "not believe in" a huge portion of your actual, literal job. Does he just write down "idk, pt is sad"? How can he not believe in diagnosis while saying you meet the diagnostic criteria for PTSD and CPTSD (which are both disorders that are diagnosed). There is functionally no difference as a clinical professional between knowing a patient has PTSD and diagnosing them with PTSD. This man strikes me as a grade-A moron.

 

[BrokenHalo91x]

Ask him why he is working as a clinical psychologist if he "doesn't believe in diagnosis." How does he do insurance paperwork? You have to write something. You can't just "not believe in" a huge portion of your actual, literal job. Does he just write down "idk, pt is sad"? How can he not believe in diagnosis while saying you meet the diagnostic criteria for PTSD and CPTSD (which are both disorders that are diagnosed). There is functionally no difference as a clinical professional between knowing a patient has PTSD and diagnosing them with PTSD. This man strikes me as a grade-A moron.

Yeah, I almost got mad. But managed to refrain. I am planning on calling him out with it this week as I've had time to think and process. I have written a whole speel on my notes in my phone. His reaction will determine if I have the same psy by 2 minutes past the hour

 

[whiteraven]

This man strikes me as a grade-A moron.

A bit harsh. My T doesn't "believe" in diagnoses, either (and doesn't take insurance. It took me a long time to pull a dx out of him, which I asked for *if* he had to make one). He's not a moron, I assure you. Has several doctorates. He uses them, because that is what his job currently uses to create treatment plans, etc., but he believes that labels do more harm than good in the long run. He also believes that they are limiting.

he has said that he doesn't believe in diagnoses, that I probably wouldn't meet the criteria for cptsd, because I don't have Re-experiencing symptoms??

So I read this as, he finds the way diagnoses are currently presented are limiting. You have all the symptoms of cPTSD, but because the *current* diagnosis (which, incidentally, was just created by a panel of people with a variety of opinions) says you have to "re-experience" your symptoms, oh well...it doesn't fit. If you *are* experiencing them every day, maybe it would help to discuss this with him and ask him to help you understand his views.

 

[Friday]

Good News / Bad News

1. It’s NOT as simple as Trauma = PTSD or Complex Trauma = CPTSD.
- Trauma can equal a whole helluva lotta different dx’s.
- Complex trauma can equal a whole helluva lotta different dx’s.
2. More than half of people diagnosed with PTSD recover, within 6mo, with no therapy or intervention.
3. Over 90% (93-96%) of people with PTSD recover fully (asymptomatic).

So IF you have PTSD? The odds are overwhelmingly in your favour, to be living your best life, very very soon.

IF?!? >>> Yeah. The fact that he won’t diagnose you means that you might not have PTSD at all. (You have to have PTSD, before CPTSD becomes possible. And even then? Severe PTSD is worse than Mild CPTSD. They’re not a severity scale, by it symptom constellations.). You might have something faster/easier to deal with (like an infection affecting your nervous system, or hormonal imbalance, or a transitory disorder like Acute Stress Disorder). Or you might have something far more complex/long term (many many many types of brain injury, any of several difficult to treat physical conditions, or a lifelong static disorder instead of a cyclic one like PTSD).

So I am seeeeeeeriously PISSED OFF at this asshole, for flinging one of many many many maaaaaaaany possibilities at you… and then just leaving you in the lurch. Not ordering a psych physical (which includes MRIs & CTs & blood/urine & & &), or Psych Differential Testing (a couple of hours long series of tests with thousands of questions, and then the post test interview; for example? Med Pros almost always “test” as hypochondriacs, as do parents of kids with cancer, and a few other populations. They’re almost never so. It’s the profession, or sick kid, or, or, or… which creates the focus. The interview, post test, which explores “high” answers to certain questions… & Changes the ratio/scale applied. Because SOME med pros, parents of sick kids, etc. ARE hypochondriacs. (Or whatever that series of as is looking at). But most aren’t. So the I post testing interview is CRUCIAL to a correct Dx. As is the series of tests. As is? The psych physical.

NONE OF WHICH he has even made a possibility for you by his half assed
“I don’t believe”.

Brick wall, bang head.

ASSHOLE.

Not only are you dealing with everything you’re dealing with, but you’ve got THIS guy leading the way. FFS.

What symtpoms do you guys and girls suffer with on a daily basis and also when triggered?.

Oh, that varies, tremendously.

Years with zero symptoms.

Years with almost every symptom in the book, but? Months with only one symptom at a time, nowhere near threshold for diagnosis, but incrediably common with PTSD. As well as days with every symptom.

Nothing… one… everything… all extremely volatile. That’s the nature of PTSD, though. It’s an extremely reactive (see stress cup) & cyclic disorder.

 

[BrokenHalo91x]

Good News / Bad News

1. It’s NOT as simple as Trauma = PTSD or Complex Trauma = CPTSD.
- Trauma can equal a whole helluva lotta different dx’s.
- Complex trauma can equal a whole helluva lotta different dx’s.
2. More than half of people diagnosed with PTSD recover, within 6mo, with no therapy or intervention.
3. Over 90% (93-96%) of people with PTSD recover fully (asymptomatic).

So IF you have PTSD? The odds are overwhelmingly in your favour, to be living your best life, very very soon.

IF?!? >>> Yeah. The fact that he won’t diagnose you means that you might not have PTSD at all. (You have to have PTSD, before CPTSD becomes possible. And even then? Severe PTSD is worse than Mild CPTSD. They’re not a severity scale, by it symptom constellations.). You might have something faster/easier to deal with (like an infection affecting your nervous system, or hormonal imbalance, or a transitory disorder like Acute Stress Disorder). Or you might have something far more complex/long term (many many many types of brain injury, any of several difficult to treat physical conditions, or a lifelong static disorder instead of a cyclic one like PTSD).

So I am seeeeeeeriously PISSED OFF at this asshole, for flinging one of many many many maaaaaaaany possibilities at you… and then just leaving you in the lurch. Not ordering a psych physical (which includes MRIs & CTs & blood/urine & & &), or Psych Differential Testing (a couple of hours long series of tests with thousands of questions, and then the post test interview; for example? Med Pros almost always “test” as hypochondriacs, as do parents of kids with cancer, and a few other populations. They’re almost never so. It’s the profession, or sick kid, or, or, or… which creates the focus. The interview, post test, which explores “high” answers to certain questions… & Changes the ratio/scale applied. Because SOME med pros, parents of sick kids, etc. ARE hypochondriacs. (Or whatever that series of as is looking at). But most aren’t. So the I post testing interview is CRUCIAL to a correct Dx. As is the series of tests. As is? The psych physical.

NONE OF WHICH he has even made a possibility for you by his half assed
“I don’t believe”.

Brick wall, bang head.

ASSHOLE.

Not only are you dealing with everything you’re dealing with, but you’ve got THIS guy leading the way. FFS.


Oh, that varies, tremendously.

Years with zero symptoms.

Years with almost every symptom in the book, but? Months with only one symptom at a time, nowhere near threshold for diagnosis, but incrediably common with PTSD. As well as days with every symptom.

Nothing… one… everything… all extremely volatile.

Its been 4 years for me and the symtpoms have remained constant. I was off work for 3 years (yes you read that right) because my stalker/harassed/ abuser was my work collegue I didn't even attempt to return until he was no longer employed
I moved house, stations, moved my son schools etc. I just want my life back

I'm barely hanging onto my job by a thread atm.

Barely hanging on to life in general by a thread. I am so happy I found yous guys!!

 

[Weemie]

but he believes that labels do more harm than good in the long run. He also believes that they are limiting.

Honestly, @Friday's response about sums it up, for me. "I don't believe in diagnosis" is half-assed, especially if your patient is seeking diagnosis and treatment. Labels might be limiting, but they also rule out physical problems, make way for paperwork for disability applications, and qualify you for treatments that you might not be able to access without a diagnosis.

You may be fine with your psychologist (a big part of their role which is diagnostics) refusing to diagnose you if you don't need a diagnosis.

If a schizophrenic came in and required antipsychotic medication because they were seeing and hearing shit that isn't there, you'd better believe that diagnosis is positively necessary, considering how many physiological problems can result in similar symptoms and how dangerous antipsychotics are (and how, if you don't treat with antipsychotics - and you'd better be certain the patient needs them - schizophrenia is neurodegenerative).

He uses them, because that is what his job currently uses to create treatment plans, etc.

And this is where your clinician differs from the OP's. Your clinician uses them, because he understands that diagnosis is a necessary part of his work. The OP's clinician is literally refusing to diagnose them due to "not believing in it."

It's just not as simple as writing off the entire medical model as purposeless for every patient. That is, in fact, straight up negligence. He also said that the OP doesn't meet the dx criteria because they don't re-experience events, when 1) the OP literally is seeing him because they're having flashbacks, and 2) the OP is telling him that they do, for 3 months now, and is telling them that they actually had to quit their job over it for at least 3 years.

Negligence and tomfoolery. Moron is polite, actually.

 

[BrokenHalo91x]

Honestly, @Friday's response about sums it up, for me. "I don't believe in diagnosis" is half-assed, especially if your patient is seeking diagnosis and treatment. Labels might be limiting, but they also rule out physical problems, make way for paperwork for disability applications, and qualify you for treatments that you might not be able to access without a diagnosis. You may be fine with your therapist because you don't need a diagnosis.

If a schizophrenic came in and required antipsychotic medication because they were seeing and hearing shit that isn't there, you'd better believe that diagnosis is positively necessary, considering how many physiological problems can result in similar symptoms and how dangerous antipsychotics are (and how, if you don't treat with antipsychotics - and you'd better be certain the patient needs them - schizophrenia is neurodegenerative).


And this is where your clinician differs from the OP's. Your clinician uses them, because he understands that diagnosis is a necessary part of his work. The OP's clinician is literally refusing to diagnose them due to "not believing in it." It's just not as simple as writing off the entire medical model as purposeless for every patient. That is, in fact, straight up negligence. He also said that the OP doesn't meet the dx criteria because they don't re-experience events, when 1) the OP literally is seeing him because they're having flashbacks, and 2) the OP is telling him that they do. Negligence and tomfoolery.

Moron is polite, actually.

Yeah he actually told me that was a re-experiencing symptom. As I had no idea! All I knew was I felt like it was in danger and had a massive panic attack I felt shit scared it took 5 days to recover from that.

I just want to know what's wrong with me. That's literally it.

Patients don't go to hospital or the doctors with physical medical conditions and the GP or consultant refuses to diagnose them. I just don't get it.

Why tell me I have something, then take it back

 

[Charbella]

Yeah I agree with @Friday and @Weemie this is a clinical psychologist or psychiatrist their JOB is to diagnosis. My therapist might not use a label (he does) but at Least that could be an I don’t have the expertise to do it.

If a client was constantly referring to their inability to do something because of a diagnosis than it makes sense for a doctor to say let’s not put a label on it let’s deal with what’s in front of us. But don’t tell me you don’t diagnosis when it’s your job.

 

[Sideways]

I mean, me and my pdoc/T stopped caring about diagnosis a while back. I’m not sure when it was exactly…but there comes a point, very often with complex trauma, where it isn’t necessary helpful to turn much on the point of diagnosis.

I still need to have an ‘official’ diagnosis for one of my medications. But that’s about the extent of it being helpful.

If I was to concern myself with my “official diagnosis”, I would be facing a shopping list, thanks to the hot mess that the DSM has become.

But, having gotten to know me, and the way my trauma has affected me, the path forward with my pdoc at this point in treatment is irrespective of whatever label is currently fitting. And moving forward, the approach we take with my treatment will necessarily have to stay fairly dynamic, rather than fixed around “this your diagnosis, so this the treatment”. Because my treatment needs have changed every damn year I’ve been in treatment, and will likely continue to do so.

Diagnosis is valuable.

That said, I have a lot of time these days for trauma therapists in particular who choose to not get too hung up on the diagnosis. Ts who are comfortable with the vastly different ways that the consequences of trauma play out pathologically, the dynamic way that treatment needs to shift depending on a number of unfixed factors.

Trauma therapists need to be able to treat the patient in front of them. Because we may all come with one diagnosis, but the treatment required from one patient to the next, one appointment to the next, varies hugely.

I think it’s a bit rough to call this T a moron or such. It’s entirely consistent with humanistic psychotherapy to be not be all that fussed about getting a diagnosis fast and fixed.

 

[Weemie]

That said, I have a lot of time these days for trauma therapists in particular who choose to not get too hung up on the diagnosis.

And I'm similar. The longer you go being mentally ill and having the same set of symptoms, the less concerned with diagnosis you eventually become. I still think it's stupid for him to refuse to diagnose his patient for an absurd reason, and I would argue that most of us who eventually move away from labels still benefited from a diagnosis at first glance. There are so many problems when it comes to this shit that we, who have a diagnosis, really have no room to be like "oh well who cares about the label?"

Right but if your doctor refused to diagnose your problem, I am sure you would give a shit. Because first of all, being diagnosed offers legitimacy, especially when your problems are extremely severe (which both of ours are). I've been hospitalized a few times now and being diagnosed with stuff is always taken more seriously than going "oh well I think I have XYZ but idk, my therapist won't diagnose me."

Also, because what is wrong with me is not something that is well understood, if I explained all of my symptoms to a doctor absent my diagnosis, I guarantee you they would have no idea what to do for my treatment, because before I received a diagnosis, I never got proper treatment. Because some of us have shit wrong with us that is very rare, and under-studied, that clinicians haven't encountered before. When you're a zebra (which we both are), diagnosis matters.

Being diagnosed also is necessary to go on disability, which many people require because they can't work. Like yes, it's easier for me to no longer concern myself with diagnosis now that I know what the problem is. Why would I care about diagnosis, just for its own sake? It's 100% obvious what is wrong with me, and the label offered me the language with which to convey it. That's independent of anything official, sure. But like I said, I know what is wrong with me because those labels exist.

So it's very easy for me to disregard the labels now that I've got that information. Eventually we will probably remove one of my diagnoses from the DSM altogether and follow ICD protocols - and I don't really care, because again, I know what the problem is. But the OP literally doesn't know and this guy is refusing to tell her or work with her in any meaningful way, going back and forth on "well you don't have the symptoms, you do have them, you have PTSD but I won't diagnose you with it."

I also think that even in terms of trauma + symptoms, the more effective treatments definitely will require diagnosis in the future. Ketamine, psilocybin, MDMA, etc. These are gold standard treatments for PTSD but you can't just walk in and say "the label isn't that important to me" and expect to receive these types of therapies. I'm fortunate to live in Canada, where access to psilocybin is in a legal grey area, but diagnosis becomes a lot more relevant when you are looking at these types of therapies even for just PTSD.

We're not morons or stupid for preferring an absence of labels, but this guy is for refusing to do the bare minimum for trauma + symptoms. We can afford to take a humanistic approach because when we were determining the problem, they ruled out all the other shit that could be wrong with us and told us it was psychiatric. This person doesn't even have that peace of mind because no one will test her for anything.

 

[Sideways]

There’s a lot of projection going on!

that I probably wouldn't meet the criteria for cptsd

Tbh, this sounds a lot like a T who is not yet convinced that cptsd would be the right diagnosis.

There is nothing helpful about offering a diagnosis that is potentially (never mind likely) wrong. The T has already made that mistake once (“sounds like an emotional flashback, it might be cptsd”).

I get the need for a label. The statement “it might not be cptsd” is not a reflection of suffering.

Diagnosis, accurate diagnosis, takes time. Especially with a condition like cptsd that has only existed for less than a decade, and where diagnostic criteria aren’t even certain.

Where the T is thinking that the working diagnosis is probably wrong (like in this case) it’s unethical to offer a diagnosis, no matter how important it might be to the patient.

Fixating on a side statement about how much importance the T places on diagnosis is missing the point. This T is turning their mind to diagnosis. If they didn’t care about diagnosis at all, they wouldn’t have an opinion on whether cptsd is right or wrong.

They think cptsd might be wrong. So they are considering the diagnosis.

They don’t have the answer for you yet. They’re thinking about it, and they don’t think cptsd is right at the moment.

And that’s okay.