To not want to see a psychiatrist?

[PitterPatter3]

I had an initial appointment with a very experienced clinical psychologist to talk about birth trauma as I am now pregnant again. She said she would need me to see a psychiatrist for a full assessment as I may have PTSD and antenatal depression. This would be another £500.

Personally I don’t feel this is necessary. I don’t think I am depressed and certainly am not at a point which would justify taking drugs in pregnancy, so that’s not something I would consider right now. Do I really need to know whether I meet the diagnostic criteria for PTSD? Can the psychologist not just get on and treat the trauma without me having to waste additional time and money? Is it usual for a psychologist to insist on an assessment from a psychiatrist before starting work?

I was treated for un-official PTSD by a psychologist. So long as they are experienced in PTSD, they should be able to recognise it and respond accordingly (the wrong treatment can make it much worse). But I think being pregnant would make it higher risk and I'm not surprised that they'd want you to see a qualified doctor first.

You can get a diagnosis from a MH practitioner at your GP surgery or a local IAPT service free of charge.
There may be an argument for exploring the diagnosis because not all therapeutic modalities are suitable for people with experience of trauma. Some can be very triggering, for the lack fo a better word, and they are probably being cautious.

Think only a Psychiatrist can diagnose PTSD? Depends if you need a formal diagnosis? As PP has said, other MH professionals, can treat trauma histories. MH diagnoses are a funny and increasingly contested thing - there's a move in some quarters to less pathologising formulations which understand the self in the context of what has happened, and see symptoms as the associated survival behaviours.

Would you not expect an experienced clinical psychologist in private practice to be able to do this themselves? DH thinks it’s just a racket and that the two of them are laughing all the way the bank, but that’s the kind of thing he would say. I’m genuinely not sure whether I’m being unreasonable here.

Do I need a formal diagnosis? I don’t particularly want one.

I have a private psychologist; she suspects I have a couple of things not previously diagnosed with my NHS psychiatrist (I have one major diagnosis but she also suspects I have body dysmorphia and has suspected some neurodiversity). However the label has not really mattered to her; she has just got on and treated the presenting problems, the diagnoses have not been important. I have never felt the need to collect diagnoses and she has never seen the need for me to either.

Then there is your answer and fwiw, can’t say I blame you as diagnoses can be stigmatising and once they’ve been put in your records it’s there for life, even if you make a full recovery.
Most decent MH practitioners don’t need a diagnosis to treat you, they should tailor your care plan to the symptoms causing your particular distress, most mental illnesses have significant overlap with each other anyway but can present very differently in the individual patient.
all the best with your recovery journey and look after yourself 💐

No. I think it has to be a psychiatrist that gives a medical diagnosis

Giving you the brush off...
Or concerned about risk?

There is no reason you need a diagnosis or meds if you don't want them. She should be able to work with the presenting problems and make her own formulation so it is a bit odd if she is pushing you to see the psychiatrist. I am afraid I would wonder if she is making an excuse and putting you off

Sounds like you need a hypnotherapist trained in birth trauma or a psychotherapist who specialises in it.

Bollocks to paying five hundred quid for someone to decree, yes, you have PTSD. You don’t need that. Find someone who can actually help you and support you - a psychologist is not the best place to start. Good luck.

Would it have any particular value to you? If there are situations where it would be helpful to have a diagnosis on record, it will depend who does the formal diagnosis in your CCG? Not usually a job for primary care.

But otherwise, if you tell health professionals you have a trauma history and need a trauma informed approach they are normally pretty helpful. (Worth reading up on what a trauma informed approach is, if you are not familiar, so you can self-advocate in services, or your psychologist will be able to advise).

Have you seen the NICE diagnostic guidelines (you'll have a fair idea your self!):

https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/diagnosis/diagnosis/

Not sure if you have read around trauma at all, but there's some interesting and accessible work by Bessel van de Kolk (The Body Keeps the Score is the go-to text), Judith Herman, Peter Levine and others (all on Audible too).

Very sorry that you have had such a difficult experience.

I would imagine it is for the reasons suggested by others - eg risk, diagnostic complexity - but if you’re not sure just ask her why. An alternative explanation to your husband’s rather cynical one is that she wants the opinion for well founded clinical reasons. Mostly, professionals want to take good care of their patients, whether private or NHS and are mindful of resources so wouldn’t suggest a review unnecessarily.

You shouldn't need a formal diagnosis. A clinical psychologist should be able to treat the symptoms if they meet the criteria. The wellbeing/IAPT services do it all the time by using EMDR

Are they really a clinical psychologist registered with HCPC? Because if so they absolutely can diagnose (and do) within their field of expertise. Are they thinking you need medication? Is that why they want you to see a psychiatrist.... To be fair most things you would prescribe around PTSD could be prescribed by your GP...

You’ve got birth trauma and you’re pregnant again. A diagnosis might help inform your treatment and delivery options through your current pregnancy and birth. I would seriously consider speaking with the psychiatrist.

I'm an experienced perinatal clinical psychologist. We are qualified to diagnose, although tend to rely more on a thorough assessment and ongoing collaborative formulation with the client. Unless I felt the client would benefit from a meds review, I would see no need to suggest a psychiatry appointment.