Any recommendations for a helpful mental health practitioner person in the area of Portland, Oregon?

May 21, 2009 1:25 PM

Any recommendations for a helpful mental health practitioner person in the area of Portland, Oregon? After a few stressful months of medication issues, my boyfriend and I have lost a lot of faith in our psychiatrist, and are looking for additional forms of help and advice, whether a therapist, counselor, or even just a different psychiatrist.

We'd both been on ADD medication for a while (I'm on Adderall, he was taking Vyvanse) when my boyfriend (Charles) began to feel that maybe he was depressed. So in January, on the next trip to the psychiatrist, the doctor gave him a prescription for Zoloft. That seemed to be going pretty well, but I didn't ask too many questions about it because I didn't want him to feel weird about being on anti-depressants.

A month later, his prescription ran out right as we were leaving on a 2 week vacation to the other side of the country, and my kind and funny boyfriend started acting like a manic irritable whackjob who saw mystical signs everywhere.

Once we got back to Portland, I managed to get him into the doctor's office again after a week or so, and by the end of the session the doctor was worried enough to put Charles on Zoloft for a little longer, but had him taper down over about a week. The doctor also sent home a sample bottle of Zyprexa, with vague instructions ("take this if stuff gets too much, or if you get too irritable.). This curbed the manic behaviour, and things settled down for a while, but he was still acting weird and saying weird things, and our friends started to notice and get concerned.

This gets us to the beginning of April, when I get a call from Charles' work, since I'm his emergency contact. They think it's best if I come pick him up. They had a meeting to discuss his erratic behaviour, and it became obvious he wasn't in a mental state to talk about it. So another round of calls and doctors appointments and now meetings with human resource folks follows. The doctor now decides that mood stabilizers are in order. Hellooo, Tegretol.

Life has calmed down a bit. My boyfriend's on meds, he's back at work, and we can talk and hang out and be a couple again. Although his work and his union has been really great about all of this, it's been a downer for our relationship and our friendship. Walking down the street can be overwhelming for him. After months of coping with all the ups and downs, I'm starting to get exasperated, even though I know better.

We both are carrying a grudge against our doctor, for various reasons. Neither of us feel that he gives enough practical information about the medication he dispenses. The recent incidents surrounding the antidepressants made me remember how little info I got when the same doctor first put me on Adderall. I used the internet like crazy, but it feels like I had to dig up my own solutions, even though this guy is supposed to be really good at ADD stuff.

My impression is that the doctor didn't give my partner enough warning about how anti-depressants are sort of a big deal, and the last thing you want to do is go off of them suddenly.

Our doctor also seems too willing to indulge philosophical meanderings, which is fine when you're feeling normal, but even when Charles was getting over the paranoid, manic episodes, the doctor didn't tone down the philosophy, and it left Charles feeling weird.

The last time we saw the doctor together, the doctor said that the episodes and behavior were signs of something that probably would have come out anyway, in a couple years. After spending the last couple months scouring the Psych/Disorders section at the bookstore, I do see his point, but it's also really hard not to have him even even acknowledge that maybe none of this would have happened if my partner had just stayed on the medication. I have close friends who've given me way better practical advice than our doctor has, and that's disappointing.

So I'd like to go see a new doctor, psychiatrist or otherwise . Charles is a little burnt out on meds and doctors right now, but accepts that after the last couple of months, it's important to have someone sane to check in with every now and then. He's still on the Tegretol, but is disgruntled about the apparent complications that medication has brought into his life.

I don't know enough about the big wide world of mental health people to know exactly the term for what I'm looking for. Someone who can be practical about real life, someone who will help us find our personal goals and then follow through with them. Someone who's good at talking to a couple of ADD twentysomethings.

posted by brisquette to Health & Fitness (7 answers total)

I'm a little confused as to whether you are seeking couples counseling or individual therapy here. It seems very odd to me that you two would want to see the same mental health professional for your individual issues. Shouldn't you each be seeking your own individual therapist? While you may have similar issues to resolve, it's clear from your question that your problems aren't identical, and you would almost certainly each benefit from a more individualized approach to mental health care. I can't see how either of you-- or your shared therapist-- could possibly feel comfortable that sharing a therapist (or therapy sessions, even? It's unclear to me whether this is the case) could foster the openness and frankness that are required to make therapy successful.
posted by dersins at 1:56 PM on May 21, 2009

Best answer: That said, it sounds as though you might be well served seeking therapists who specialize in Cognitive Behavioral Therapy, which is "a psychotherapeutic approach that aims to influence dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure."
posted by dersins at 2:16 PM on May 21, 2009

Best answer: I know your question has to do with referrals to specific people in your area, but there are some things that caught me in your description of what's going on.

First of all, why are you both seeing the same doctor, and sometimes going to each other's individual appointments, and why is the psychiatrist ok with this?? Have you both signed releases to specifically let the other partner in on your individual appointments? Even if you have signed releases, I can't think of a good, clinically useful reason for this to be happening.
Second, if you are taking psychotropic medication, this psychiatrist should have followed the basic standard of care by referring you for some individual therapy in combination with the medication, especially in your boyfriend's case.
These two factors added together make me very wary of this doctor. He seems to be irresponsible AND violating some important ethical boundaries.

Advice: You may want to check out the website for your county's Department of Mental Health, or a "Therapist Finder" directory online for a provider near you who works in the specialized areas you need help with. Get separate therapists--these will be psychologists, marriage and family therapists, or clinical social workers--and separate psychiatrists for your medication needs. If you're really lost for finding a therapist, you can ask the psychiatrist for referrals and he has to provide them.
posted by so_gracefully at 5:44 PM on May 21, 2009

Response by poster: When Charles and I moved in together, we enjoyed most of our shared ADD characteristics, more or less. He had been diagnosed as ADD as a child. Last summer, we had the thought that maybe he would benefit from some ADD meds, too. A lot of his concerns were very similar to the ones I had, and so we thought he'd give it a shot. My doctor seemed like a reasonable idea, at the time.

We both had separate periodic visits with the doctor. The only time I entered the doctor's office at the same time with my boyfriend was when he had gone off of the medication, and was acting really loopy. I got him in there under the pretense of "Even if you've found a new plane of existence, if you care about me, we need to find a way to talk to each other. Let's ask the doctor about how we should deal," and then talking to the doctor before hand about both of us going in together. It was the only way I could be sure that the extent of his mental health issues would be communicated. He had a tendency of drastically understating his actions.

Since things got weird, I've had to be a bit more involved. Sitting in at some of the work stuff, making sure prescriptions get picked up, fielding some phone calls and helping with paperwork.

At this point, it seems like we might benefit from both couples and individual therapy, whereas before we were really only looking for some ADD counseling stuff. How to develop better patterns, how to sort out feelings, etc. But it's been a rough several months, and some couples stuff could help.

I had always assumed I would want to talk to one doctor about both aspects, since they tie into each other a lot, and I'd want someone who "got" what we were going through.
posted by brisquette at 6:20 PM on May 21, 2009

Response by poster: The CBT thing is a great lead, thank you, and the therapist finder for Portland looks like it can sort by that criteria.
posted by brisquette at 6:24 PM on May 21, 2009

If you don't feel comfortable with your current physician it's a good idea to find someone who you feel comfortable communicating with. Have you let your current psychiatrist know that you would like more information about the drugs s/he prescribes? Have you asked for referrals to therapists? A psychiatrist should have a network of mental health professionals they can refer you to.

While you're putting together a mental health dream team, you can keep researching different treatment strategies while you meet with different practitioners. Just as a caveat, few physicians will tell you exactly what to expect with a given drug because psychotropic drugs affect people differently. It's also unlikely that the physician has tried the drug him/herself, so they can't offer first hand experience, but there are plenty of people who can.

Two sites that offer particularly good first hand experiences with psychotropics are CrazyMeds and Erowid. Patients Like Me is an online community of people living with ADHD, depression, schizophrenia and many other conditions, and sharing their experiences with different medical treatments and drugs. There's a lot of helpful information out there. Good luck.
posted by ladypants at 10:54 PM on May 21, 2009

Tim Foulke. google should do the trick. Great doctor, many different methods, open minded, etc...
posted by markovitch at 6:00 AM on May 23, 2009