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Just been rereading Kay Jamison's 'Unquiet Mind' and reached the bit where she says that psychiatry alone won't help bipolars, you must have psychotherapy as well. I've never had a tdoc, just a pdoc who hands out sweets. Am I alone, and if not, do you feel you did/would benefit from psychotherapy?

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Her point was that drugs can bring you back to 'normality' faster than you can adapt to it, and 'makes sense of the confusion... returns some control and hope and possibility of learning from it all. Pills cannot, do not, ease on back into reality'.

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Yes, having a therapist was immensely helpful. It helped get me from one week to the next while waiting for the meds to take hold and start to rebuild the brain. There are many scientific studies that show that meds + therapy gives faster and longer lasting results than either alone.

a.m.

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Taking the psch meds is like pulling yourself from a bad wreckage.... but you come out confused, overwhelmed, angry, scared, etc etc. I know that I for one depend on the safety of my tdoc's office every week, where I can talk out my life, both past, present and sometimes (when it seems possible) the future. I can't imagine doing this with pills alone. It truly is a joint effort.

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My vote is talk therapy...meds alone do not work for me..

I go in once a month for an hour for the last 13 yrs. On bad months I go twice a month. U learn to cope,talk,work through,get by,and lots of useful info on why u do the stuff u do. ;) It has helped me pick up the signs of depression, manic, and taught me when to avoid things that will send me spinning.

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I would be interested in knowing how the author defines "psychiatry" and "psychotherapy". In many cases, psychiatrists (our beloved pdocs) DO MORE than just hand out meds--they do therapy as well. And many therapists ("tdocs") are not psychiatrists at all so their treatment cannot correctly be called psychotherapy.

Does this author mean that no one can help us but a edical doctor who has chosen to specialize in psychiatry?? (Which is what a pdoc is and why he can write scripts).

I do benefit greatly from "talk therapy" as well as meds, and find that the ideal situation is a practitioner who does both--like the NP's I saw in Charleston. I think there are very few of us who can normalize our lives without some therapy--the meds just get us so we can actually think abut and rationally talk about our problems and "issues" (I hate that word--)

china

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Her point was that drugs can bring you back to 'normality' faster than you can adapt to it, and 'makes sense of the confusion... returns some control and hope and possibility of learning from it all. Pills cannot, do not, ease on back into reality'.

This is definitely true for me. Right now I'm feeling "well" but I don't have a grasp on what that means for me in the grand scheme, and I don't know what to do with the leftoever parts of me that aren't doing/feeling so great. I think seeing a tdoc can really help. Since I'm in the school system I see counsellors at the counselling centre at my univeristy, and I think it's really helping. Depending on what stage I'm at in my illness the therapy might not help so much - sometimes you really do need a med tune-up to get you going. But most of the time therapy leaves me feeling much better about myself and gives me a goal to strive towards. I highly recommend it. ;)

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I don't think I'd make it without my therapist. She helps me look clearly at things in my personal life and definately helped me through the long period of finding the meds that seem to be working.

Tommy

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i have a different perspective than AM, so i'll share that, and can be refuted.

i agree that both the pdoc and tdoc are found scientifically to yield better results when used in conjunction and not only one or the other. however, i see meds as playing a different role in recovery from symptoms.

you'll start to see and feel some benefit from meds usually as early as 5 days and up to 10 days to feel something happening, and usually a month to reach maximum benefit, or longer, but usually in that range. with the short time it takes for meds to kick in, it is expected that the meds will lift you out of suidicality and kick mania's ass before any psychotherapy will. psychotherapy is the long-term solution, however meds are what will be key to ending a hospital stay and returning us to normal life faster.

they don't turn to psychotherapy as the front-line treatment for an accute psychiatric episode, they give you zyprexa or another powerful agent to bring you around. the therapy is vital for understanding and insight, and will help restructure your brain- in time. we won't have this insight right away, and the brain doesn't restructure so quickly- not like it does with meds.

as i said, no therapy will get you out of the hospital as quickly as meds will. take the old days, when there were no drugs. they only provided therapy, or outdated drugs that provided less benefit than those we use now (in some cases. lithium is still used as a front - line drug). anyway, people were in the nut house for months and months while waiting for their condition to stabilize, whereas now the average hospital stay is between 7-10 days, if that. i usually stay for about a week. that's as long as it takes for a powerful agent like zyprexa to stabilize me, and the therapy is a part of the longer term solution.

that's just my take. there could be contradictory studies, and maybe you guys know different info than i do. however, these are my observations. also, meds help you rise above all of the crap in your life and take life easier so you are at a point where you are able to really participate in therapy and benefit from it enough for it to have the chance to change your brain.

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Do you think that you have anything to work on?

Probably. I still question the whole dx bit from time to time (though the book brought home the reality), but mostly I wonder about how to deal with the wreckage I left behind. A lot of it is old stuff, but do I need closure, or just let it be? If most of my adult life was in a strange BP world, who am I? What was true?

All that existential shit.

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UR--

Chalk a point up to "yes" for the tdoc.

I totally agree that in highly neurological/biological psych illnesses such as BP, the first and foremost treatment should be meds. My personal experience is that the meds primed me down a little bit and made me more attentive and receptive to therapy suggestions. For example, Cymbalta helped with my rejection sensitivity and actually let me digest constructive criticism given by the therapist.

But, remember to find the right tdoc. What the right tdoc exactly is, is up to you.

(n.B. - Interestingly, 4 years ago, a psych prof of mine at college speculated (or rather, reported) to us that the standard for treating schizophrenia and other psychotic states was to administer meds until the psychotic individual could get a grasp on the real world, and then to start therapy and continue the meds.)

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If most of my adult life was in a strange BP world, who am I? What was true?

Yep, those are exactly the kinds of things I explore with my tdoc. I'm another yes vote for how helpful they can be.

I'm lucky to have found a really awesome tdoc, after a couple of false starts. (As others have pointed out, finding the right match is crucial.) In addition to the just having a completely safe, nonjudgemental place to hash out whatever's on my mind (not a small thing in itself), I do bounce questions off her about "Is this 'normal'? Do you think I'm reacting appropriately or more going off on my own weird stuff?" As someone who's mentally interesting - and also grew up in a hugely dysfunctional family - I often feel as if I didn't learn "the rules" of normal life and relationships that others seem to take for granted. I trust her judgement in helping me figure out these things. I also trust her judgement as to when I need to think about tweaking my meds, although as an MSW she can't personally prescribe, so I then have to see the pnurse.

She also helped me realize, slowly, that I could and should take care of myself and my illness, rather than continuing trying to take care of everyone around me and ignoring my own needs. In a way, the insights I gained working with her helped me give myself "permission" to do this. Might not sound like much, but it was a big big breakthrough for me.

Good luck in making your decision.

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I have a few trusted friends I confide instead of conventional therapy. One is a therapist who graduated with me and lives across state. I can ring her with a specific problem and get some positive (or not so positive) feedback on occasion. I journal & get insight on the cycles of my moods and how I handled them, what worked, what didn't. I have a few male friends who I can discuss things I can't with other females (I tend to gravitate towards being more open with males, I find them less judgemental) A good, real life therapist can be a godsend. I loved one of mine but she moved away. No money to be made in community care, can't fault her for that. She had that southern drawl- she dyed her hair pink. She told me weeks after that I was the only client who didn't comment on her hair. I wonder how she analyzed that- I never notice things like that. I notice a kindred spirit, an aura, a feeling, a whole package. I think she really thought I was nuts then. It's like I noticed the hair on a subtle, subconcious level, not an outright blatent one.

Damn, I'm chatty tonight. Some learn more from conventional therapy- different approaches, exposure therapy, past life regression can help if you believe it will, who's to say what therapy has the highest sucess rate. Can anyone site any long term statistics? I'd be interested in it.

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