It is now quite common for patients to be seeing a psychiatrist/nurse practitioner and also a therapist. Their psychiatrist/nurse practitioner may like to focus more on assessment and on prescribing medication. Just like there are excellent prescribers and not-so-great prescribers, there are excellent therapists and not-so-great therapists. It is often hard for a prescribing clinician to evaluate how the therapy is going, what happens during the therapy, and so on. Personally, what I like to do is to speak to the therapist periodically and pay close attention to what the therapist says.
Anyway, talking to therapist is time consuming when I am seeing many patients who have an independent therapist. I usually like to ask my patient directly about the therapy. I like to ask the following three questions:
1. “You have been seeing Ms. Smith for 3 months. What does she think your problem is?”
Often the patient is puzzled by this question because the therapist has never said anything explicitly about this topic. In such cases, the patient says something like, “She thinks my problem is depression.” To which I respond, “No, you went to her for depression. What does she think is the reason for your depression.” If the patient shrugs and says, “Well, she hasn’t really said anything about that,” it is not a good sign.
2. “What is her plan regarding your therapy? What are you working on with her?”
Unfortunately, the patient frequently has no idea and says something like, “The plan it to help me become less depressed.” If the patient is unable to add anything to this, there is probably no specific plan. I try my best not to roll my eyes.
After this, I may still try to give the therapist the benefit of the doubt. Maybe the therapist does have some formulation of the patient’s problem and a plan to help the patient, but the patient just doesn’t know it (although that is not good for the therapy either).
3. “So, when you go for your therapy sessions, what do you talk about?”
I cannot tell you how many times I have seen the patient shrug and say, “Well, it depends on what is going on. We talk about different things in different sessions depending on what I bring up.”
Unfortunately, a lot of “therapy” sessions start with the therapist asking, “How have you been? What’s been going on?” and the patient giving a lengthy narrative about some upsetting thing that happened that week. Often what happened that week is not really new but is just yet another example of an ongoing problem, e.g., with the spouse, the parent, etc. Little changes. Next week, it will be something else. Maybe you need to talk to your psychiatrist/nurse practitioner and consider the possibility of changing to another therapist?
Copyright © 2016, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
Disclaimer: The information on this website is intended for general educational purposes only. It is NOT intended as a substitute for medical advice. Patients must ask the clinicians treating them, Dr. Mago or others, for advice specific to their situation.