The Two Most Important Relationships With Bipolar - Part Two

Today we are going to talk about the second most important relationship you can have with bipolar disorder. We will discuss finding a psychiatrist. Psychiatry is not an exact science. There are no tests or physical exams to determine that you have bipolar (not yet at least). Your diagnosis is going to come from the symptoms you describe, and not just from one session, but over a period of time where the psychiatrist can get to know you (avoid one that wants to diagnose you in one session). This places more responsibility on you in finding a psychiatrist you can connect with.

A BRIEF HISTORY
There used to be a biological/psychological split in how psychiatrists were trained. Biological training involved teaching a psychiatrist to be a doctor that provided diagnosis, medication, and psychotherapy (usually psychodynamic oriented). As time has progressed, the emphasis has changed and is now focused on diagnosis and medication treatment. Many times a psychiatrist will work hand in hand with a therapist. Mine does. Personally, the best therapists and psychiatrists I have ever had have worked together.

A CONSIDERATION

In 2007, a study was done between psychiatrists, nurses, and patients. Each was asked to rate the most important keys to a successful relationship between psychiatrist and patient. Almost 50% of psychiatrists felt that "ability of the patient to communicate" was the most important key. Around 40% of patients felt "being a good listener" was the most important key. This brings us to our first point.

YOUR RESPONSIBILITES
The more information you are armed with about your symptoms and management, the better. Educate yourself. Keep a mood log. Make a list of questions and/or concerns. Be ready to discuss how you have been since your last visit with your psychiatrist. Learn as much about bipolar as possible. There is no one definite place to research the symptoms of bipolar. I would suggest starting with NAMI and NIMH. This will give you a general idea. Remember that each person has their own journey with bipolar. For me, I quickly lose the ability to sleep whether I am in a hypomanic or depressive state. Many people report that when in a depressive state, they want to do nothing but sleep. So, because psychiatry is not an exact science, the psychiatrist needs meaningful communication from you. Help them help you.

There are a few other ways to help your psychiatrist help you:

• Stay medicine compliant - this means taking your meds every single day, at as close to the same time as you can manage.
• Be willing to make healthy lifestyle changes - diet, exercise, and sleep, etc.
• Be reasonable and expect reasonable outcomes - because psychiatry is complex a combination of evaluation and treatment, and the choosing and monitoring of medications, it may take months to find a med set that works for you. Patience may be something you will have to have.
• Be punctual and prepared - most likely after your initial office visit or diagnosis, your psychiatrist will manage your visit into 15 minute time blocks. They need to treat efficiently to be affective. Having a list of questions and/or concerns, along with your mood log, is a good way to help that happen.

A FEW ASSUMPTIONS
If everything is right, there are two things in your favor:

• Location
• Insurance/Finances

If you are missing either of these key advantages that allow you to have the freedom of choice, finding your psychiatrist match will be difficult. You may be left with choosing the best you can find even if it isn't the best match. If insurance/ finances are an issue, contact your local NAMI chapter or your local mental health center. They will help point you in the right direction. Unfortunately, most psychiatrists will not work on a sliding pay scale.


CHOOSING A PSYCHIATRIST

• Referrals - ask your family doctor. Ask your therapist. Call your insurance company and find out who is in your network. Use Psychology Today to find a psychiatrist close to you.
• Specialty/Focus - if you have bipolar disorder and a psychiatrist doesn't specialize in mood disorders, you will not accomplish anything. Make sure the psychiatrist treats your age group.
• Experience - I like the saying, "practice makes better". While this won't guarantee a better psychiatrist, someone who has experience in practicing has had the opportunity to have worked with all kinds of individuals.
• Availability - Is the psychiatrist available during off hours for emergencies and crisis's? Some psychiatrists belong to a group of psychiatrist that share on call duties. If they don't, your only option in a crisis will be 911 or a crisis hotline.
• Shop Around - Nothing says you have to stay with the first (or even subsequent) psychiatrist you choose. If you educate yourself about bipolar, you probably have a gut feeling on what you need to manage it when your mood is relatively balanced. You deserve to work with the best person possible for yourself. Be your own advocate for self care. A good psychiatrist will strike a balance between making sure you are on the right medications, but not too many or too few. I have been through quite a few psychiatrists. I was diagnosed with PTSD in December of 2014. After a few months, my psychiatrist looked at me and told me I was "going to have to get over it". He never offered medicinal help for the violent nightmares I was experiencing. I didn't even have any idea there was anything out there for PTSD nightmares until June of this year. I now see a different psychiatrist. You are most likely willing to shop around for the best buy on something you want. Don't be afraid to shop around for the right psychiatrist, also.

A GOOD FIT

Around 40% of you reported finding a good listener was the most important factor in a successful relationship with a psychiatrist. So, you are going to see that a few times below in the suggestions because it is important. A good listener will listen without interrupting. They will also ask questions relevant to what you say. Find a good listener. If your responsibility is to communicate, then the psychiatrist's responsibility is to listen. They should be able to repeat, or paraphrase what you say. In fact, ask the psychiatrist to tell you what they heard so you make sure you and he or she are on the same page. That may seem uncomfortable, but it is part of being your own self care advocate. Here are some suggestions on finding the right one for you:

• Bedside Manner - Are you comfortable speaking to your psychiatrist? Do they display empathy and compassion? They should have good listening & observation skills. They should spend time educating you. They will listen to your concerns, input, perspective, opinion, questions, and are willing to discuss any and all of those with you. You should feel like you are a partner to your psychiatrist and not simply expected to do what they say. It is important that you are heard if you disagree with their observations or treatment decisions. An excellent psychiatrist will even ask your opinion, collaborating with you and coming up with plans that work for both of you.  If you see a psychiatrist that seems rigid, intimidating or disrespectful towards you when speak up, it may be time to seek someone else out.
• Method - Most psychiatrists are going to meet with you for an hour on your initial visit and then schedule you for 15 minutes appointments after that. Stay away from psychiatrists that meet with you for less than an hour on your initial visit. It will take time to get to know you to treat you most effectively. They shouldn't be in a hurry. Neither should you. If you feel the psychiatrist doesn't have enough information about you after the initial visit, speak up! You have to be your own mental illness advocate. A psychiatrist should also see you once a month at first, gradually weaning you to every three months. The psychiatrist should be willing to see you in between times if you think you need to. Some psychiatrists will not hesitate to write a prescription, and some think less is more. Regardless of their method, they should be following you closely and listening to your questions, observations, and concerns.
• Knowledge -  Psychiatric diagnoses are complex. The symptoms you have often overlap between different disorders. Even if a psychiatrist thinks they know what disorder you have, they will consider a broad range of possibilities. This is where your knowledge can be an advantage and can (secretly) test how knowledgeable your psychiatrist is. I do it all the time, but I am careful in how I approach it because, of course, my knowledge is layman at best. This will also tell you how well you will partner with your psychiatrist. The same about knowledge can be said when it comes to your treatment. There isn't one set of medications that work to manage bipolar. Your psychiatrist should discuss a variety of treatment solutions with you.
• Ethics - unless you live in a very rural area, do not enter into a relationship with a psychiatrist that treats a family member. You shouldn't even use a psychiatrist that treats a friend. This potentially compromises the psychiatrist's ethical responsibility and could skew their treatment.

Finding a good psychiatrist is trickier than finding a good therapist. More than anything, they need to be wiling to listen and partner with you. You need to communicate and speak up for yourself. With those things together, you will be able to find a good fit.


To balanced and productive days my friends,

Laura