Psychiatry, Psychology or Psychotherapy?

[ImaHogg]

Does anyone have any experience in any of these.
I am quite confused as which therapy would help me.
I am going to have to pay privately for this and can’t not afford to make the mistake of choosing the wrong type.
My gp just offers me CBT which I have had many times and sadly just doesn’t help me.
I have suffered from severe anxiety for many years (probably 40 years on/off), it’s started in childhood during which time I had many fears and anxieties.
It has waxed and waned over the years but has been very bad recently to the point I is now controlling my everyday. I have obsessions, unwanted thoughts and several different types of anxiety which are taking over my life.
I am in a vicious cycle of physical symptoms which exacerbate the anxiety and vice versa.
Because of the awful health anxiety which I have I am too scared to take medication and feel that I need a health professional who can support me with the right medication. My gp will just give me a prescription for antidepressants, check in two weeks later and then leaves me to it and doesn’t understand the absolute fear I have of taking such medication, I need someone who can help get me through that. I wonder if a Psychiatrist would be the best for that? I have no idea!

I don't have any practical advice but I just wanted to say that I really hope you get some help as that sounds awful to live with.

Best of all would probably be a psychiatrist who offers psychodynamic therapy (a sort of psychotherapy) as well as medication.

@OwlBasket

Best of all would probably be a psychiatrist who offers psychodynamic therapy (a sort of psychotherapy) as well as medication.

Most psychiatrists don’t offer therapy.

Psychiatrist if you want medication.

Clinical psychologist if you want therapy.

Something else to consider is the possibility of an underlying undiagnosed neurological disorder such as autism or ADD/ADHD - these have often been overlooked in people of your age, especially if you're female.

Psychiatry is medical and their primary model is diagnosis and medication which doesn’t sound as if it would suit you.

It sounds as if you need to see a clinical psychologist who is able to assess you and recommend a treatment pathway. CBT is only one option and is mainly offer in primary care via your GP. A clinical psychologist could consider a variety of other therapies and over a longer period of time. Some people benefit from a period of grounding and stabilisation prior to cbt. CAT, psychoanalytic and trauma therapies are all potential options to consider.

You have two options really, see if your GP will consider referring you to the mental health team for further assssment. They can think holistically about whether you need help in other areas and the impact on your daily living - ie work, getting out and about. But their threshold is high and there will likely be a significant wait for any psychological input.

Alternatively you can pay privately for a Clinical Psychologist, often they are trained in several different areas and can develop a treatment plan for you. This will be expensive but a good option for those that can afford it.

Psychiatrist if you want medication.

Clinical psychologist if you want therapy.

Agree. Psychiatrists only do drugs and sometimes inaccurate diagnosis. Appointments are 15-30 minutes tops. They assess and review symptoms, possibly social factors, then offer drugs and review those drugs. They may pick up on medical factors affecting you as they are medically trained.

If you have had difficulties going back to childhood you need a clinical psychologist. Preferably one with an interest/expertise in that area.

They can't prescribe, so you could potentially see a psychiatrist every 6 months to do medication reviews whilst seeing a clinical psychologist weekly for therapy. If that's the right answer for you.

Psychotherapist would be useful for mild difficulties, but would be wholly inappropriate for what you describe.

I was hoping to find a psychiatrist who can also offer some form of therapy as I really would like help with medication too.
I have never had anything other than several different counselling sessions and cbt. Is the kind of therapy you get from psychotherapy different from counselling? Counselling was good at the time but didn’t really help long term.
cailleach thank you, I have read of this and have often wondered as I can honestly say that I feel my brain functions differently from most people that I know! Would a psychiatrist be the best person to see if this is the case?

TolkiensFallow thank you, I will have a look at look and see if I can find a local clinical psychologist.
malteserheist thank you, that is very helpful.

You would need to be referred for assessment by your GP. Read up on the condition you think best fits your difficulties then make a list of all those points then take it to them - be prepared to be fobbed off or at the least for a very long wait for assessment, in which case you may want to pay privately for one. You need to see someone who specialises in developmental disorders in that case.

There is a board on the SN section on here called Mumsnetters with Special Meeds, which may be of some help.

*needs

@Cailleach

Something else to consider is the possibility of an underlying undiagnosed neurological disorder such as autism or ADD/ADHD - these have often been overlooked in people of your age, especially if you're female.

Definitely...often co-existing with anxiety, etc.

Thanks.
I have just had a look at ADHD in adults and I can tick almost all of the boxes. Will need to talk to my gp.

I work with a number of psychiatrists who offer therapy, in fact of the 5 we have only 1 doesn’t and that’s because he’s a temp. Psychodynamic therapy is of v v long term and he’s only with us for a year.

@ImaHogg I am very much in the same situation as you. I have had anxiety on and off all of my life. I have been on medication for most of my adult life but over the last couple of years it has gotten worse and is like yours, dominating my life. Worse still I can now see signs of it in my son. This panics me more. I have had CBT several times but struggle to maintain the effects of it. I have made an appointment with a psychiatrist as I have never in 40 years, actually seen one. I have only seen a GP. I am hoping he may change my medication and shed some light on my situation.

OwlBasket I will keep my eye open for a psychiatrist who also offers therapy.
Macs1 I totally understand about dc. My ds is 15 and has suffered with anxiety on/off for quite some time and had quite a bad time with it 4 years ago, the guilt I felt was overwhelming, Imgot him counselling straight away, I do not want my dc to suffer as I have, it’s held me back in so many ways, I do not want that to be their future.
I hope all goes well with the psychiatrist, good luck, you deserve a good life free of anxiety.

An integrative clinical psychologist is probably your best option. You can refer yourself through IAPT but keep in mind that adult ADHD assessments have a long waiting list (2 years in my area). Be open about what you have tried and what you are hoping for in the short and long term.

Thank you @ImaHogg. I feel the same overwhelming sense of guilt and responsibility. I agree in it holding me back too. So many times wasted by being paralysed with anxiety. It’s not a good quality of life at all is it.

If you want to explore a neuro-diverse diagnosis, a clinical psychologist or psychiatrist is your best bet. There are some very knowledgable psychotherapists who work with neuro-diversity but they can’t diagnose you.

dane8 do you think your anxiety got much worse during menopause? I feel the same, although I have suffered from anxiety since childhood I did get the odd respite during my younger years but not now, now it is consistent and I wonder if my hormones are exacerbating things?
Macs1 no it really is not a good quality of life. I feel your pain, I honestly do
Craftycorvid thank you, I will look into that.

Have you had any exposure and response prevention (erp). It's a specific kind of CBT designed to help you to confront your anxiety full on and learn to reset your nervous system. In a nutshell your nervous system is in a permanent state of alarm (fight or flight). Every time your anxiety leads you to avoid something, or distract yourself from it, it heightens the anxiety because you are training your brain to think that you really are in danger and it produces even more anxiety. It's a vicious circle.

Retraining your brain to sit with the anxious thoughts, resets it and your nervous system will gradually calm and realise it no longer needs to be on full alert. Paige Pradko does some really good YouTube videos on it. It might be worth having a look before you commit to any particular type of treatment. I'd also look at Therapy in a Nutshell, which is all about how to process difficult emotions and learn to do EFT (e.g. Brad Yates)or yoga. Vagal toning exercises also help to calm your system. These are all good ways to reset your autonomic nervous system so that your parasympathetic nervous system (which calms you) is in balance with your sympathetic nervous system (the fight or flight).

All of these are free and will help you alongside any therapy you decide to do. I also wonder whether you have experienced any childhood trauma? This will also be a consideration about what kind of treatment might work best for you.

Another question to think about is, are you a perfectionist or do you feel overly responsible for others? The answer to that might give you a clue about whether or not your anxiety has a physiological basis.

Sorry to hear you're struggling OP. There is no way of anyone knowing where you should start without knowing what is available and how it works in your local area. Your GP should be able to inform you of what is available and make referrals if necessary (for some services you might be able to self refer).

There is no way of someone on the internet being about to tell you what kind of intervention you need, it would take a formal assessment to determine that, so my advice would be to not get caught up in trying to find a particular treatment that someone who has never met you recommends. A mental health professional may also be able to determine whether you have traits indicating ADHD, but what they are able to offer regarding that depends on where you live.

Good luck OP, start at the GP and go from there

Thank you everyone.
dane8 I feel for you, anxiety is just an awful thing to live with, it controls every waking minute of my life right now.
grimacingfrog I have only ever been offered basic CBT on the NHS, nothing like you mention. Thanks for the other info, I will look into those.
theworldhasgoneinsane Thank you. Unfortunately the reason I have had to take to the internet to ask is simply because I get absolutely nowhere with GPs (I have seen 5 over this issue at two different surgeries). Maybe because I am quite high functioning I come across as ok but I most certainly am not, they just offer CBT even though they know I have tried it 5 times with little success. My issues run deep and from years ago. I have come to the conclusion that my gp is not going to offer me much more help, I am going round in circles with them. My only option is to go privately. I have little experience with private mental health treatment and am concerned about making a costly mistake as I don’t have money to throw at it, sadly. I appreciate we all have different needs with our mental health issues and each area offers different therapies etc but I just need some advice from people who may have experienced any of these therapies. I really feel that I am stuck between a rock and a hard place right now.

Hi @ImaHogg

CBT is very useful but I find it isn’t long lasting - you need to have refresher treatments regularly otherwise it’s easy to slip into old habits again.
Have you ever tried medication? I have found that to be really helpful in evening out the very worst anxious times. There is a place for medication if things are very bad for you. I really empathise with you because I think sometimes I seem very together and ok when that is often not the case.