This is my first post. I'm two months into my six-month (hopefully) journey to RNY. My surgical practice requires 5 appointments for evaluation, with my insurance company requiring it be with a psychiatrist. I just went today for my 4th appt., and mentioned something about next week being our last meeting. Dr. laughed and said "Oh no! You're in THERAPY now! You have at LEAST 5 more visits, then we'll see." I want to deal with any issues to help me be successful after surgery. But I didn't sign up for open-ended psychotherapy. She's already said I'm an excellent candidate for WLS. I'm not depressed, have no mental defects, just some issues from my childhood (who doesn't have those?) which I'm willing to work on. It's hard to express-but I feel that I should be the one to make the decision whether I'm in "THERAPY" or not. I realize I can walk away, but that won't get me life-saving surgery. This doctor has worked with this surgical practice for at least 5 years, and I wonder sometimes just WHO she's working for-me, or them. I don't even have a surgeon assigned to me until she gives the OK. Has anyone else had this kind of experience? As I've said, if I need to work on issues, I'm ready, willing and able. Thanks in advance for any advice.

I havent had experiences like this.

It sounds freakishly unethical.  She is there to evaluate you for surgery, not give you ongoing therapy. Sounds sort of liek a conflict of interest to me.

Lets see what Cierogirl says.  I think she works in mental health...

No, that wasn't my experience.  And you are absolutely right, you should be the one to decide if you are "in therapy" or not.  I'd discuss this with her.  And I'd ask her who she is working for.

I plan on discussing it with her, for sure. But it's a bit intimidating, because this woman can veto my surgery if she chooses. She told me 20 minutes into our first session I am an EXCELLENT candidate for WLS. Now I'm questioning her honesty, because she said the same thing last week! I mentioned as I was leaving today (we were literally at the door) that next week was our last session. That's when she sprung this therapy thing on me! No discussion, nothing! I want to be equipped for success after the surgery, of course. But this just doesn't feel right. Anyway, thank you both for your advice!

You need her OK to have surgery with the particular surgeon you've chosen, is that correct?

But you could switch to a different surgeon if you wanted?

It doesn't sound right to me.  And if you do decide to get some therapy, maybe you'd choose to do it with someone else.  Someone that treated you like a equal participant in the process.  Someone that respected your wishes.  Someone that you trusted more.  If you do need therapy, you should have the right to choose a therapist.

I think you got excellent responses from Kelly.  If your insurance is paying for the sessions, which is almost certainly the case, then the Psychiatrist is working for YOU. 

Five sessions for an "evaluation" is very unusual.  One session is usual, and two sessions is not uncommon (which is what I utilize, but the majority of the second one is used to review the results of the questionnaires given at the end of the first 90-minute session), but I cannot for the life of me think of any reason that they should require 5 sessions for everyone.

You are correct that YOU should be the one to determine whether or not you are "in therapy" (which, BTW, very few Psychiatrists actually do... They usually only do enough "therapy" to understand what is going on and to prescribe appropriate meds, and they leave the counseling to Counselors, Psychologists, or Social Workers). 

To be honest, it sounds to me like the Psychiatrist is being unethical by abusing the inequity of the relationship (she knows that YOU know that you NEED her evaluation) and is simply attempting to line her own pockets.  What kind of documentation did you sign at your first visit (along with the stuff about confidentiality, etc.)?  Did it indicate that it was for a specific number of sessions or that it was ONLY for the purpose of determining whether you were a suitable candidate for surgery? 

Did the surgeon specifically send you to this Psychiatrist?  If so, I would talk to your surgeon directly (not just a nurse, PA, or a receptionist) and express your concerns (and let him/her know that it reflects poorly on his/her practice to have "their" Psychiatrist trying to force people to pay for this indefinite course of "therapy". The surgeon may have no idea what is going on.  

If the surgeon is non-responsive to your concerns, you may want to consider going to a different surgeon (and only doing a one-session psych eval).

Lora

Lora, you are a God-send! It means so much to know these concerns of mine aren't 'all in my head' so to speak. The document I signed did not specify # of sessions. But I get the distinct impression this is how this woman deals with EVERYONE who comes to her for this 'service'. In other words, she LIES-having a different agenda than the one I'm actually there for. It will be a HUGE inconvenience to be forced to go to another city for surgery/follow-up, etc., but if I have to, I WILL. I'm placing my life in these individual's hands, LITERALLY, so I must be able to trust them. I plan on having a list of questions on my next appointment. Which was scheduled to be my last. Which will probably BE my last one. Again, I can't thank you enough for your advice and support!

Let us know what happens.  And do let the surgeon know how the psychiatrist treated you, regardless of whether you end up sticking with that surgeon or switching to someone else.  He or she should be aware of this and it's quite possible he has no idea she's behaving this way.

The papers that my clients sign is very specific about the purpose of the evaluation and identifies the two sessions required.  It also indicates that if I believe that additional therapy is needed in order to move forward with surgery, we will provide a list of recommended therapists the client can choose from (if they do not already work with someone) OR they have the option of working with one of us.  

If they work with someone else, they are asked to sign a release for communication with the other therapist (to let the other therapist know the specific concerns standing in the way of surgical approval and to get feedback from the other therapist periodically in order to "sign off" on the psych approval).  That means that the client doesn't ever have to see me again if they don't want to.

If they opt to work with me, I have them sign an additional paper that indicates that it is intended to be short term unless the client expresses a desire to continue.  In that case, and for clients *****ach out to us for counseling AFTER their surgery, there is a third set of paperwork.

Part of the ethical "informed consent" means that clients and providers know, and agree, on what services are being provided and under what restrictions or limitations, and that the clients understand potential outcomes (e.g., that the pre-op assessment is NOT just "checking a box" and, in rare cases, may result in delay/denial of surgery, or -- for ongoing therapy -- that the process may stir up negative emotions).

Everyone has their own paperwork, so that varies a lot (other than what may be required by state law) but the more I thought about this situation last night, the more it bothered me from an ethical standpoint.

Please do let us know what happens!

Wow. What you just described bears NO resemblance to the document I signed. I need to ask for a copy (again) for my records. If I am forced into seeking another psychiatrist for approval, I pray they are as professional as you! My next appointment is this coming Thursday (Sept. 11th! of all days) and I will let you know how it goes. I have the feeling I won't be the first person to question this 'procedure'. Thanks again!