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Coordination of Care: Why do therapists talk to psychiatrists?

In the world of mental health treatment, we have a variety of specialties.

You have met your therapist, completed an intake, a treatment plan, and set out on a journey to help solve some important issues during weekly meetings. You love your discussions. The "chemistry" between you is great!

Your therapist may be a clinical counselor, a marriage and family therapist, a clinical social worker, etc. One day he or she brings up your symptoms again and suggests that you see a doctor. A psychiatrist of all people!

You are shocked and offended! You certainly did not expect a twist of fate like that! You feel disrespected by this wild suggestion! What happened to the nice "chemistry", you wonder. You kick yourself for settling for a curmudgeon of a therapist like that.

You thought that the discussions with the therapist were going pretty well. It's true: your insomnia has not budged, nor has your exhaustion and fatigue, nor has your irritability, panic attacks, sadness, hopelessness, mood swings, weight gain, crying spells, and a feeling as if there is a constant dark cloud hovering over you.

You remind your therapist, who casually brings up psychiatry as if it were a mere walk in the park, that you "are NOT crazy", that we all go through problems, drawing a bigger line in the sand for the therapist to notice and signaling again and again that this topic is off the table. You fold your arms to reinforce your point and protect yourself.

Suddenly, there is an awkward and deafening silence filling your session as you try to change the subject to your vacation plans, but the damn therapist keeps reverting back to the idea of sending you to a psychiatrist, "for a consultation".

How did something so comfy and cozy suddenly turn upside down and get derailed so quickly?

Your therapist, it turns out, does this all the time!

He or she even has a fancy name for this switcheroo deal: Coordination of Care. Goodness!

You reluctantly consent and accept a list of referrals. Before you know it, your telehealth appointment with a psychiatrist or a psychiatric nurse practitioner is all lined up.

You are amazed how quickly they move from question to question, with a rapid-fire battery of clinical information being dug up about you.

"M-kay", you think to yourself, rolling your eyes and waiting for the punchline. It never comes.

The psychiatrist appears pleasant, kind of nice, very polished, articulate, knowledgeable, and not even remotely like the snake-potion-pitching charlatans they are made out to be on TV. A bit short on time, but that's ok by you!

Within minutes they know everything about your medical history and even your family's medical history!

You are now discussing your options to help you make progress in treatment. You close your eyes, keeping your fingers crossed that they won't embarrass you, and find yourself nodding and saying "Yes!" to the psychiatry provider.

Your friendly pharmacist next door fills your prescription the same day, and you take your first dose.

No, the earth did not quake, there was nothing even remotely remarkable about any of the events of that day, you agree. You got your money's worth and a top-notch service! You even got some much-needed time off work to heal, authorized by this provider! Wow!

Before you know it, your follow-up appointment arrives and you are doing better! You chat away with the psychiatrist as if you have known each other for ages!

The time off work your doctor gave you, the meds, the therapy you do on the side, the coordination your providers do amongst themselves on your behalf are all gelling nicely! You now delight to wake up in the morning, start a new day feeling renewed and re-energized!

Thank goodness for coordination of care!


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