Dear Mari

the bad delusional time when he SHOULD have put me on an antipsychotic and DID NOT. input from me was irrelevant then because my mind was past where i could know i needed that. rather than spend the ENTIRE hour losing logic games to my contorted mind which made me even more fearful, he needed to switch gears at some point and tell me - if need be convince me - to take Zyprexa until he got back. even proposing it as the only calming agent that would help with the fear, whatever - anything to get me to take it. i needed medicine. he didn't even SUGGEST it.

there were other briefer incidences of the same, but that was the worst.

also the time i agreed to retry Paxil, warning him it had made me full manic the first time - he prescribed 40mg (that is the MAX dose), no titration. I may even have taken less on my own caution, but I still ended up with EPS in few days - less than it took to get manic the first time... but since when do you max out the start dose for a pt that has already had an adverse reaction to a med? helloooooo?????

NOW do you still think in terms of 9/10 on meds?????????

for CBT, knock that down to 2/10. that's supposed to be his main therapeutic area but what few CBT techniques i might have learned have come from elsewhere. we have not done CBT to speak of, no goals, no structure, no exercises, nothing resembling CBT.

he gets a 9/10 for being collaborative, that's what. he will write me scripts for just about anything "reasonable" including non-psych scripts. but also at one point i had valid scripts for no less than 5 different benzos for different uses. i doubt most docs would do that, and i doubt he would with most pts either. he knows i know how to mix and not overdo, moreover that i am more conservative than he is wrt benzo use.

he does get 8/10 for supportive therapy.

yes, that is true.[quote]a new pdoc may well adopt an attitude of arrogance if i asked too much and/or questioned what they prescribed or made suggestions.

if my line of work lets me afford it. chances are i will have to do state, but i might look for a tdoc to do specific work with on an infrequent basis. like hypnosis or dream work or working with feelings in a more direct way. i feel like he turns expression of feelings into a type of dialogue which defuses the intensity and derails the feelings that instead needs work. then i leave feeling like lots of threads were pulled out... and left hanging, despite a seemingly "logical" conversation.

you are right. one step at a time. first i was just scared he'd drop me. but after it seemed that way i think i got defensive about the imminent rejection. and the long-standing ambivalence got me thinking maybe it would be for the best. but i know it would be very hard for me right now too.

and also, a state pdoc or tdoc would not be someone i could text or call whenever most likely, either. besides, good or bad practices aside, my pdoc is a good guy overall and i have an emotional attachment at this point.

~ waves ~