Bad psychologist or is it me?
April 30, 2012 12:36 PM   Subscribe

Did I get a bad psychologist or is there a valid reason for a chemical dependency evaluation?

Went to a psychologist for the first time in years today, namely because depression/suicide runs in my family and haven't had a through depression screening done in years. On the intake, I also listed goals of "help w/ life goals, alcohol abuse, and stress management skills". I've recently stopped drinking, and am doing fine by it but I'll also admit that I have problems with binge drinking. It's either sober or drunk to me, more sober then anything.

Anyway, so the psychologist starts the initial intake, does some further depression screening, states that I'm on the border for mild depression. Then says he will not help me unless I get a chemical dependency evaluation as that will clear all my problems right up. When I questioned him about the life goals, stress management skills, his response was cold and pretty much repeated that a chemical dependency test was needed. I never lied about drugs (occasional pot), or the amount I drink, so I really don't see what a chemical dependency eval will accomplish as I'm not hiding anything and have a good idea of my triggers. To me, it seemed like he was blowing me off since I don't have any quantifiable issues besides alcohol. I should also note that the entire visit took 28 minutes with 10 minutes of filling out forms.

Did I get a psychologist who really doesn't want to help, or is there some valid reason for a chemical dependency eval?
posted by lpcxa0 to Human Relations (18 answers total) 1 user marked this as a favorite
Both, probably.

It is pretty routine for a therapist to suggest that a new client who has had issues with substance abuse (including a history of binge drinking) get a chemical dependency evaluation.

It is not at all routine for that therapist to suggest that said evaluation would "clear all {your} problems right up." I would look for another therapist myself.

A half-hour intake visit seems short, but it may be the norm for the practice in question; it may also be all that your insurance provider will normally cover.

Best of luck to you.
posted by Sidhedevil at 12:44 PM on April 30, 2012 [1 favorite]

Avoiding the "bad psychologist" question, and having no idea if you really need a more detailed chem dep eval, I would argue the first lesson in looking for a psychologist is finding one that you can work with. It is not uncommon at some point for them to push you a bit, but... if you are already questioning the fellow after 28 mins then I would hazard a guess it isn't going to work well.

Not, really answering the question, but the drunk or sober, binge drinking is a big flag, however I think you know that.
posted by edgeways at 12:46 PM on April 30, 2012

The valid reason is you put that you have had alcohol abuse troubles in the past. A chemical dependency fucks everything up so I'd just do what they requested then see what happens. Keep in mind that not everyone is as honest as you were being so the skepticism, while unwarranted in your case, exists for a reason.

Or make an appointment with another psychologist. It's really no big deal if you do. You should trust the person whose aid you're seeking so that might be best.
posted by OnTheLastCastle at 12:47 PM on April 30, 2012

Yes,there is a valid reason. The psychologist may not have handled this issue in the most useful way but your comments about binge drinking, occasional pot use and reference to quitting drinking is a flag for additional evaluation. Maybe a poor analogy but it would be like telling a physician you used to have chest pains but since you quit smoking a month ago they have gone away so there is no need for a stress test. Any ongoing substance abuse ( or even uncomplicated use ) can be an impediment to successful therapy/counseling.
posted by rmhsinc at 12:50 PM on April 30, 2012 [3 favorites]

The substance abuse evaluation is probably fairly routine given your background but you'd think your psychologist could just, you know, talk to you about your relationship to drugs/alcohol. (It sounds like there might be something to talk about... you say you've stopped drinking but have problems with binge drinking? Most people would consider these conditions mutually exclusive.) And it seems rather unhelpful that he refuses to talk to you about any of the other problems you're dealing with, the ones you actually are seeking therapy for, until you get said screening.

Find a new psych, one who is willing to meet you where you are and work with you on the problems that you want to work on, not one that wants to make you fit into whatever prefabricated boxes he happens to think you should slot into in order to be a "good" client.
posted by Scientist at 12:50 PM on April 30, 2012 [4 favorites]

Best answer: This sounds relatively normal. Each psychologist approaches treatment differently. Some do not work with co-morbid individuals (those with chemical dependency & a psych diagnosis). Some do. Some specialize in it. He/She may be asking for the screening to determine what is "primary" in your diagnosis (is the dependency causing depression? or the depression causing dependency?) or determine the course of treatment.

The 28 minute visit is interesting...did you see an actual PhD psychologist or an MD psychiatrist? Some intakes may be only 30 minutes's been a while but once upon a time I could do an initial hospitalization assessment in 10 minutes. However, that didn't include a full psychosocial history, just the problems leading to hospitalization.

Bottom line is that you need to feel comfortable with who you are seeing. It's important to note that if you've never done this process before, you may be feeling uncomfortable and overwhelmed by the process and not the person. It's hard to tell in 28 minutes. If you have another appointment scheduled I'd consider keeping it and discussing with him/her how they approach treatment, what they see as goals for you, and what their general style is. If you aren't making a connection after that then check for other options. Sometimes the intake process is a little weird (it shouldn't be, but after asking 1000 questions it can feel a little odd).

Whatever you do, don't give up! There will be a therapeutic "match" for you that will get you moving in the right just may not be the first person you meet.
posted by MultiFaceted at 2:32 PM on April 30, 2012 [1 favorite]

Since I didn't "directly" answer your question: Yes, the chemical dependency evaluation is valid. You endorsed a history (and/or symptoms) of substance abuse. That alone triggers additional questions to explore that issue deeper. This particular psychologist may want to have that done by a Board Certified individual instead of doing it on their own.
posted by MultiFaceted at 2:34 PM on April 30, 2012

Best answer: Yes, this is valid. If a client comes in with both chemical dependency issues and psychiatric issues, the appropriate response is to address the chemical dependency issues first, since substance abuse can mimic or mask psychiatric issues. For example, if a person comes into my facility with a history of crack cocaine use and is displaying manic behaviors, we don't know right away whether the mania is due to an underlying psychiatric disorder or due to the crack abuse. Your provider is behaving ethically.

I am a mental health provider who works with both psychiatric and chemical dependency issues but I am not your mental health provider.
posted by catlet at 2:48 PM on April 30, 2012 [3 favorites]

Nthing both.

Valid reason: binge drinking messes with your neurotransmitters. So what looks (and feels) like borderline mild depression might actually be a side effect of this other factor. (Or to put it another way, it could be real depression, but with a very specific underlying cause, that may not be amenable to the customary treatments.)

Bad psychologist: treating you like a messy experiment that needs to have its variables tidied. (An understandably callous habit when lots of your patients are addicts in denial about addiction, but unless you're a nostalgic House fan, you'll probably want to find a less antagonistic clinician.)

On preview: what catlet said.
posted by feral_goldfish at 2:52 PM on April 30, 2012

It is very valid, however, that doesn't mean you have to agree with his way of going about it - if you find him too cold and clinical, I suggest finding another psychologist. You two have to be able to work together.
posted by mleigh at 3:23 PM on April 30, 2012

I've recently stopped drinking, and am doing fine by it but I'll also admit that I have problems with binge drinking.

so, is it a problem or not? is it having a negative impact on your life now? my guess is that it's not since you say "I've recently stopped drinking, and am doing fine ..."

since you don't currently have a problem, i'd say bad psychologist. he's essentially calling you a liar: he's saying it is a problem when he says you must get a screening. how can you trust someone like that?
posted by cupcake1337 at 3:40 PM on April 30, 2012

On the intake, I also listed goals of "help w/ life goals, alcohol abuse, and stress management skills".

If you listed alcohol abuse as an issue you would like to address, it would be negligent of your psychologist not to perform a chemical dependency screen. While you may not think it is necessary, any mental health professional needs to have this information in order to treat you effectively.

I have doubts that your psychologist said a chemical dependency evaluation will clear up your problems. Most psychologists just don't roll this way. This may, however, have been what you heard. If he did say this, it was either a careless choice of words or an indication that he may not be the right professional for you.

When someone has multiple issues going on like depression, stress, substance abuse etc, it is going to be difficult, if not impossible to address depression without arresting the substance abuse first. It's kind of like a meth addict getting Xanax for anxiety without telling the doc. they're using amphetamines.
posted by space_cookie at 4:25 PM on April 30, 2012 [3 favorites]

Best answer: What on earth is a "chemical dependency evaluation" that requires a referral to another practitioner after an intake evaluation? I don't get it. Why didn't he ask you detailed questions about your drug and alcohol use? isn't that a "chemical dependency screen"? A psychologist in clinical practice should be capable of evaluating the contributions of alcohol and other substances to a prospective patient's presenting problems.

Then again, I wouldn't "screen" for depression in the way he did either, and then say I "found" that you were "on the border for mild depression." This is supposed to be science, I guess, because you filled out a questionnaire? And this "specialist" he wants you to go to has different questionnaires about drugs and alcohol that the guy you went to has no access to?

This is all very weird to me.

I am a mental health provider (clinical psychologist) who has worked with both psychiatric and chemical dependency issues, including a stint with Daytop Village (a chemical dependency mini-empire), and, although I am not your mental health provider, I have never once in my 28 years of practice heard of any psychologist referring a new patient out for this separate "screen."

On the other hand, I'm in New York City, which is maybe kind of like another planet from the rest of the United States? is that it?
posted by DMelanogaster at 5:36 PM on April 30, 2012 [2 favorites]

I've read articles that state some doctors will double whatever amount is giving for drinking, smoking, or drugs - so if you say a monthly binge, they assume biweekly, etc. He may be trying to get a true baseline for drug and alcohol usage w/ out calling you out.
posted by blackkar at 6:42 PM on April 30, 2012

Response by poster: I'm not really sure what the deal is either, but it's enough to raise some red flags to me since one of the reasons I went to him was due to practicing in a large practice with other psychologists and psychiatrists (I went to a psychologist). One of his specialties listed on his bio was also "alcohol/drug addiction" and now he's referring me to a recovery home for an outpatient chemical eval instead of another therapist or MD within the practice? Something just seems off, so while he might be a good therapist, I'll keep shopping around for a therapist that I'm more comfortable with.

And bad wording on my part about the clearing up - he was referring to the depression symptoms.
posted by lpcxa0 at 6:57 PM on April 30, 2012

Wait, he's sending you for an intake screen at another facility, for treatment at that facility? I'm with DMelanogaster - I thought maybe he was letting someone else in the practice do a screen (intern or something), especially since it doesn't sound like you're looking for intensive daily therapy.
posted by catlet at 7:50 PM on April 30, 2012

Are you paying out of pocket or through insurance? Because this could be an insurance-mandated thing.
posted by Ragged Richard at 9:04 PM on April 30, 2012

It might be worth your while to ask him about his rationale for referring you out. Even if you don't stay with this person it might give you some insight into the evaluation process in general and how he reasons decisions out and communicates his reasoning in particular.
posted by space_cookie at 9:04 PM on April 30, 2012

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