When Your Doctor Suggests Seeing a Psychologist

What can this mean?

By Dr Vic Barnes

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Being told by your doctor you might benefit from seeing a psychologist may cause some alarm, confusion or misunderstanding.

The first thing to get very clear: It is wrong to think this must mean your doctor believes you are "crazy" or that your problems are "all in your mind"! The meaning of being referred to a psychologist will become clearer as you read through this brochure.

A very common question: What is the difference between a psychologist and a psychiatrist?

Psychologists: are scientists who study behaviour, emotion and perception in all contexts. Their field of interest is much wider than just mental illness. The role of clinical psychologists however, overlaps with the role of psychiatrists. Clinical psychology encompasses mental illness but is mostly about improving how we deal with, and adapt to the problems encountered in our family, social and workaday lives. And it is about personal achievement and life satisfaction. Psychologists are not medical doctors and do not prescribe drugs. They work using counselling and psychotherapy, explained below.

Psychiatrists: are medical doctors who have specialised in Psychological Medicine. In other words, they specialise in mental illness. Seriously inappropriate behaviours, thought patterns and emotions making us less able to take good care of ourselves can have a genetic or other biological cause. In these cases medical intervention is required, often in concert with psychotherapy or counselling and a psychiatrist could be the most appropriate specialist. Your doctor refers patients accordingly.

*Body and Mind are interdependent.

Biology is such that it is natural for us to fight or flee when we feel threatened. When we are threatened hormones are automatically released that maximise our bodiesí ability to do either of these as required for survival (while functions like digestion close down). When the threat passes our hormone levels and general biological balance returns to normal. The activity of "fight or flight" itself helps to "use up" those excess hormones and their effects. When the lion loses interest in the chase, the panicking herd of animals notice this and almost instantly settle back to grazing and digesting their food as if nothing had happened.

The threats we face in modern life however, usually cannot be escaped by using our muscles and rarely end quickly. These perceived stresses come from our work-life, family and social life. Some of the threats driving us are generated from within ourselves as a result of attitudes we learned in childhood causing us to be chronically vigilant. Three simple examples are compulsive perfectionism, cleanliness or approval seeking. When a sense of threat stays too long it means that our bodies are geared-up for danger too long and then things start to break down: We develop such physical symptoms as stomach aches, heart pains, dizziness, rashes, our immune system weakens and we become more vulnerable to illness. Our desperation to cope with perceived threat may drive us to eccentric behaviours, or "twitchiness" (noticed by friends, family and workmates) or painful emotional states such as panic attacks, depression and anxiety. When these latter two go together, it is commonly called a "nervous breakdown". Most of us encounter this situation at least once in our lives.

A common mistake:

It is a very human form of self delusion to think we can deal with our chronic psychological conflicts and anxieties by the application of willpower alone. This is why a "pull-yourself together" approach is ultimately unhelpful in changing onesí inner realities and their eventual consequences.

When conscious will is out of harmony with inner reality.

Doctors and psychologists commonly see patients suffering debilitating illness resulting from the tension caused by a strong commitment to a lifestyle, or a form of work for which they are not temperamentally well suited. Psychological assessment and counselling helps to investigate and rationalise the factors involved. Sometimes a lifestyle change is needed, and a psychologist can help guide and support the change process which can be difficult.

Possible reasons for being referred to a psychologist.

*You suffer a medical condition that can be aggravated by stress: Certain kinds of heart problems, skin conditions, alopecia (hair loss), some cases of torticollis (shoulder muscle spasm), ulcers or other digestive system problems are just a few examples. Some medical conditions indicate a change in lifestyle for continued well being. A psychologist can teach you stress management techniques and attitudes, and coach you through life-style changes, often as part of a "2-pronged" approach involving both medical and psychological interventions. Work Cover patients often need psychological treatment and rehabilitation counselling.

*Phobias: Irrational fears, of say spiders or birds, inanimate objects or of driving a car subsequent to motor accident, can interfere with the conduct of everyday life. Psychologists are specialists in helping you overcome these fears.

*Panic attacks: These sudden, crippling attacks of anxiety (fear) are usually related to specific situations, e.g., crowded venues such as shopping centres or conversely, wide open spaces. Psychologists use standard techniques for gradually guiding patients to overcome these attacks using behaviour modification methods often in concert with a detailed examination of onesí life history. Often these conditions, when severe, respond to a combined medical and psychological approach to therapy.

*Depression: This comes in various forms. Some sorts of depression have an organic basis and respond only to medication. The more common forms of depression result from a sense of loss, or a feeling of failure. In the later stages of life one becomes prone to depression based on an acute awareness of mortality and the difficulty if finding meaning in life. Psychologists use "cognitive behavioural" techniques to help guide clients through this depression. It is an important area where doctors and psychologists work together because depression is a very common condition. Depression is nearly always accompanied by some degree of anxiety. Sleep disturbance is also a common symptom of depression.

*Anxiety: This is a feeling of fearfulness. It can be attached to an object or situation as in a phobia or it can result from having to deal with a difficult life situation, or it can be "free floating" meaning that one feels fearful without knowing why. Psychologists use cognitive behavioural techniques to treat anxiety. Extreme anxiety is also a feature of serious mental illness requiring medical intervention.

*Personality problems: Shyness with the opposite sex, stage fright in business meetings, or a fear of approaching high status executives can interfere with social life and business life. Psychologists guide their clients through these problems with a high level of success.

*Trauma counselling: Persons who have suffered a severe trauma such as a motor accident can suffer many of the symptoms mentioned above, e.g. panic, anxiety, depression, bad dreams, "flashbacks" and specific fears.

*Childrenís problems. Poor school performance and behavioural problems are investigated by psychologists who can then help parents and teachers with approaches to managing the problem. Teenage behaviour too, is often a source of family tensions that need improved management and is helped by a psychologistís guidance.

*Relationship counselling.

How psychologists work.

Many psychologists use a combination of methods that can be thought of as (a) "cognitive-behavioural" and (b) methods that can be loosely thought of as "analytical". The former methods encourage you to see yourself and your world from a new viewpoint, to experiment with and practice new forms of behaviour. You might be asked to study the behaviour of someone who is very good at what you are not good at, or to keep a diary in which you note your behaviour and reactions at certain times or situations. The notes are then discussed. You might be shown how to relax and asked to visualise certain scenes in your mind and possibly to recall certain memories and "rewrite" them as if the memory was just a movie that needed to be rescripted and refilmed. Or you might actually be taken out into the community to practice certain behaviours in real life with a mentor by your side. The latter, "analytic" methods examine your life history, and your dreams in detail to uncover any faulty learning that might have occurred, or the symbolic meaning of any symptoms you might suffer. Regardless of the method used sometimes a psychologist will suggest using hypnosis to help you more sharply focus your concentration.

Seeing a psychologist:

Referral not needed. Private Health Cover is available. Not covered by Medicare.

Dr. Vic Barnes, Association of Australian Psychologists

Consulting at Plympton Park & Stirling Ask about "no gap-low gap" and "low income" fees.

Correspondence: PO Box 52 Crafers 5152, email: victorbarnes@itconnect.net.au

Phone: (08) 8339 5465 Fax (08) 8339 3919


PS I have asked Vic to write the above brochure as I have experienced difficulty in teaching my patients the importance of appreciating the impact of the mind on the body in both health & disease. AG You will also find some helpful articles on my page called CHANGING OUR LIFESTYLES