Psych consult

[mimi368 0]

I had my psych appointment today! I had to do paperwork first, just general information and then was given a little hand held computer that had questions on it. After that I saw the Dr. for about 10 minutes. He said I was cleared for surgery as far as he was concerned. The only thing that bothered me was that he would never let me finish my answers when he asked me questions. He would but in and start the next question. I am sure they are not all like this though. Anyway, another consult marked off the list!

[RestlessMonkey 7]

If I may approach this from a different direction....

If you are being screened for, say, Diabetes, and you don't have the disease, then the screening may be a waste of your time and money. If it is done incompetently it doesn't harm you because you don't have the disease. BUT if you have it...IF you have it...

you would expect the screening to be performed properly, you'd want the information interpreted correctly, and you (probably, unless you're in denial) would want medical intervention to prevent worsening of the disease, future loss of a limb, an eye, kidneys, your life....

In much the same way, the psych consult is a screening tool. Not everyone will test "positive" and unfortunately, some who do the screening are lackadaisical or flat out incompetent or apathetic. But the facts are that some people get the band and freak out. Some sane, happy, "normal" people who pine, yearn, DREAM of the band come to and thank "Oh my dear GOD get this OUT of me". Some "normal" people, when they find their food intake is restricted, turn to alcohol, drugs, sex. It's funny unless it happens to you.

SO...our best bet is to get the consult, HOPE it is performed properly, and HOPE it catches those who need it. We aren't all alike, you know. We may all be fat, but that's a minor similarity. Each person is, of course, entitled to think it's a waste, and some of the consults described here ARE wasteful. That's too darned bad.

Bottom line, though. Spartan, however flamboyant, is correct. No WLS should be undertaken lightly and without research, thought, and every medical and psych test we can get. If you are one of the many who have no issues with the band, the surgery (or bypass, whatever) then good. If you are one of the few for whom the band would be a dreadful disaster, let's hope it catches you.

[Ruthie1974 34]

If anyone who is reading this thinks that I have been insulting or something else, that is NOT my intention. But understand that I have been involved in weight Loss surgery-related areas for nearly a decade. I have undergone multiple Surgeries, have made many mistakes, and I have learned the HARD WAY what it takes to be a success at this. And one of the most important elements of this whole process is to pay close attention to the MIND element of this. Because THAT is where the success begins and ends.

So, when you are sent for your Psych eval, I would heartily suggest that instead of seeing it as a waste of time, think of it as another component of a successful LAP-BAND®® experience….embrace it, and consider making Psychotherapy a part of the process of becoming a Healthier person. It might be the difference between success and failure.

Spartan,

Since I am the one who started this thread I would like to take this opportunity to say, no you have not offended me in the least. I believe that this forum is for people to meet and bring ideas, thoughts, experience to the table and help others. I did not take anything you said as a personal attack, rather words to think about in this whole journey.

If you would not mind me asking, you stated that you have had mulitple surgeries and have tasted the sting of failure and had to get your head into the game for ultimate success: My question is do you regret having the surgery done? Do you feel that you would have been better off not having the surgery done?

I firmly believe that the band is not a "cure all", quite the contrary I believe that the band is only a tool. And if used properly may afford the weight loss that all of us here are looking for, and it will help keep it off. Could I loose the weight without the band, yep, done it before. But the weight always came back, with a vengence. I would like a tool in my life that will help me win this battle and the war. I have multiple resources in my life to be a sounding board, a help to get me through the process. And if I believe that a good psych counselor would help me in this process I would not be against that idea.

That being said, the psych consult I had was completly worthless. Unfortunately the psych doc I saw had talked to me for about 15 minutes, had little to add except the words, "Eat slowly, enjoy your food." I spent an hour in his office, looking at magazines, filling out paper work only to have him tell me about the most obvious statement in the world. So I do appreciate your comments about this being more head work than stomach restriction. But could you entertain the idea that perhaps the stomach restriction would give me and others like me a chance to work on the head stuff, when it comes up, without the nawing hunger as well? Good day, and God Bless

Ruthie

[RavenClaw779 2]

My surgeon's office gave me a list of four psychologists and I didn't think to ask if I could choose a provider on my own. My bariatric center is 45 minutes away, so I chose the counselor who was closest. What a ding-dong! She was late, locked herself out of her office and couldn't finish the consult in the alotted time so she had to call me at home several days later!? Her biggest concern - how she was getting paid for her time. I wasn't too surprised to hear that someone in my support group had a similar experience with her and got the similar recommendation - "Attend two support group meetings prior to surgery".

Take it for what it's worth - it's really just to weed out someone who is doing this for the wrong reasons(to please a spouse...) and someone with obvious psychological issues.

Frankly I always thought that my ability to eat a whole large pizza on my own made me a psycho - guess not!:scared2:

Edited February 12, 2010 by RavenClaw779
typo

[SoccerMomma73 1,867]

I believe that this forum is for people to meet and bring ideas, thoughts, experience to the table and help others.

Very good quote Ruthie.

I have the support of my friends, family, and co-workers through this journey, however, as a single mom with no significant other I'm mostly on my own. I am using this site to help me and support me through my weight loss journey, and, hopefully along the way help out a few others. My thoughts and ideas may not always be the same as others but that doesn't meant that mine (or their's) are right or wrong.

[stl2atl07 0]

The subject of Psych Evals comes up here every once in a while , and I am always amused while reading the responses and reactions people have. And, I sometimes get a little angry as well, because of some of the comments I see people making.

The “psych” component is one that is REALLY overlooked and downplayed by people when they are getting weight loss surgery. They complain about having to do it, and I think that is a BIG mistake.

So….I have a few…(ahem)….”comments”.

I think that many people are missing the point entirely when it comes to the Psych Evaluation portion of the LAP-BAND® (or any WLS) process.

While it varies from person to person, the problem of obesity comes down to a very simple equation: We eat TOO much of the WRONG stuff. And most of the time, we do that not because we are physically hungry, but because of the “head hunger” that so many of us experience. And, simply because it gives us physical pleasure to eat good tasting food.

Sure, there are segments of the Obese population that have some form of metabolic disorder, there are absorption issues, and some other elements that play a role in the path to becoming Obese. But MOST of the problem lies in the fact that we simply eat too much of the wrong food. And, of course, we don’t exercise our bodies nearly enough.

The fundamental mechanism of the LAP-BAND® is to restrict our consumption of food. Plain and Simple. If you eat too much, you’re gonna suffer. If you don’t chew properly, it’s gonna hurt. It’s a valve. It’s a Spigot. It’s a throttle whose job it is to keep you from eating TOO MUCH (note to those engineer-types out there: I know it’s not technically a”valve”…it doesn’t open/close. I know…but you get my point…lol). There are some theoretical elements to the LAP-BAND® experience such as reduced appetite and hunger, but that does not occur in all people….it is more the exception than the rule.

The point here is that a HUGE component of the weight loss process is the MIND GAME. It is psychological in nature, and if that particular part of the puzzle is not dealt with, you will not be entirely successful in your weight loss efforts, with or WITHOUT the LAP-BAND®. Some people get lucky and the band is all they need to lose all the weight, but they are really the exception. And, if the band stops working or needs to be removed, then you have a big problem if you have NOT dealt with the mind/emotional issues relating to obesity.

So many LAP-BAND® patients see the Band as some magical device that is stuffed in their stomach and Voila! ….they’re not hungry any more. Nothing could be further from the truth, for MOST LAP-BAND® recipients. It takes discipline, self control, patience, and a strong personal commitment to the process to make it work properly.

And THAT is why they make you go through the Psychological Evaluation. To make sure that you are up for it emotionally.

For those of you that are complaining about having to go through the process, I would say that your attitude is sorely lacking…big time. Particularly “Shonette”, who doesn’t seem to want to do ANYTHING to help herself in this process. She wants the band to do everything for her, and it’s too bad, ‘coz that AIN’T how it works. You don’t want to do the 6-month diet? Here’s a news flash for ya….the LAP-BAND® IS a diet,,,one you’ll be on as long as you have it in you. So get used to it.

Personally, I feel very strongly that regular sessions with a Psychotherapist that specializes in bariatric issues (and I mean SPECIALIZES, not just as part of the practice) should be a requirement of getting a LAP-BAND®, not just a single session before the surgery. This should be an ongoing process, designed to support you in your weight loss efforts, and help you identify and manage the issues that have driven you to overeat in the first place.

Now, on the other side of this, I do think that SOME of the consultations ARE a joke. The insurance industry really needs to do some “housecleaning” with regard to how they handle these evaluations. Some of it really is “going through the motions”, and that, honestly, doesn’t help anyone at all. But that doesn’t keep the PATIENT from taking a proactive stance and seeking out quality behavioral therapy to assist them in this process.

So, as a prospective LAP-BAND® patient you should absolutely NOT be rejecting the idea of psychological intervention in your Quest for better health,,,,you SHOULD be wholeheartedly EMBRACING the idea that your problem with obesity is multi-faceted, and needs help from multiple resources, and NOT just a noose around your stomach.

Some comments on what some of you have said here:

Cwm812: “I can't imagine any other demographic group having to have a psych consult to get corrective surgery.”

Sorry, but what you are having is NOT “corrective” surgery. There is probably nothing “wrong” with you physiologically. You EAT too much, of the WRONG stuff. It is a CHOICE you have made. The surgery will NOT “correct” that. It MIGHT keep you from eating as much as you do, but there is nothing “corrective” about it. It is NOT the same as someone who was born with one leg shorter than the other, or someone who has a faulty hip. Or a bad heart valve. This surgery is about preventing you from following through on the Bad choices you are making.

In your case, it looks like you have lost most of your weight with just the use of the band, and that is terrific. But for MOST people, but problem is a little deeper. And you have to keep in mind that there may come a time when you will have to have the band removed. There is increased incidence of erosion, slippage, and other problems that can happen with the band. These problems are surfacing in people who have had the band longer than 3 years, and it is happening with greater frequency, and more people are having to have their bands removed. So, while you may have solved the “physical” component of your obesity by using the Band to limit your intake, based upon what you have said here it is unlikely that you have addressed the psychological component; and there may come a time when you will have to live without the advantage of the LAP-BAND® and the restriction it places on your eating.

“I have no problem with psychologists. I have even gone to them for various problems throughout my life, but as a condition of this surgery, it's demeaning to have to prove that you are competent to be of normal size!”

The Pysch Eval has NOTHING to do with “proving competence to be of normal size”. What an absurd statement. What is has to do with is to make certain that you are aware what the challenges are post-surgery, and that you are capable of sticking to the rules, and willing to do the work that is necessary to reach your goal. And a GOOD therapist will want to work with you to help isolate issues in your life that might get in the way of doing so. THAT is what it is all about.

Cwm812 and 4Sammy: "I hate when we waste our medical resources in this country."

So, you guys see obesity as merely a PHYSICAL issue? Something that just “happens” to you? Something you didn’t play a role in? It’s nothing that you had a CHOICE about? That’s how you see it?

You know…there is a significant percentage of people who think that Weight Loss Surgery IS a waste of “Medical Resources”…..Many people think that we, as obese people, simply have no self-control or discipline, and that WLS is a waste of Surgical Talent that could be used on more “serious” maladies, like heart disease and cancer. As a Weight Loss Surgery patient, I do not entirely agree with that notion….but I UNDERSTAND it. I understand what they are saying. I recognize that obesity IS a self-inflicted wound. For the most part, we do it to OURSELVES. And wouldn’t it be great if we could find a way to solve the problem WITHOUT tying up Surgical Theaters and other resources? We all know that it is not that simple….BUT proper counseling and psychotherapy CAN make a world of difference to people who are struggling with weight issues. I have personal acquaintances that have been able to lose significant amounts of weight by seeking out a properly credentialed psychotherapist, and getting to the root of life issues that have contributed to large amounts of weight gain. Regular Psychotherapy played a HUGE role in my own transformation.

Christiemr: “Just one more benefit to being self pay I guess, no psych consult! Woohoo!!! In medicine we call it CYA (cover your a--) medicine. I'm sure there's one person out there somewhere who had the procedure expecting the magic quick fix, didn't do what they were supposed to, got stuck, slipped band, etc and then tried to sue their doctor so they all freaked out and started requiring the psych eval.... Just a theory.

“

Wonderful. “just one more benefit”….meaning just one less thing you HAVE to do that might very well make the difference between your being successful or failing in this process.

Shonette: “Why in the world do someone need to tell me what my thoughts or feelings need to be concerning my over weight condition. I know that am over weight and that is why am doing something about it. “

You really don’t get it, do you? It’s not about “telling you what your thoughts should be”. It’s about finding out WHY you feel how you do about eating and then coming up with methodologies to deal with those issues. And there’s other stuff involved too, but for you to discount something very fundamental to weight loss (and ANY behavioral Psychologist will verify what I am saying) is to dramatically decrease your chances for long-term success with ANY weight-loss procedure, surgery or otherwise.

“Am willing to do only those things that I have to do and nothing more.”

That is the purest recipe for failure that I have heard in a LONG time.

To kagead: It sounds like you have a Dr that’s “gets it”. I hope you keep Psychotherapy as part of your “band lifestyle”….I can guarantee that it will play a role in your success.

Ok, I have spent far too long on this.

If anyone who is reading this thinks that I have been insulting or something else, that is NOT my intention. But understand that I have been involved in weight Loss surgery-related areas for nearly a decade. I have undergone multiple Surgeries, have made many mistakes, and I have learned the HARD WAY what it takes to be a success at this. And one of the most important elements of this whole process is to pay close attention to the MIND element of this. Because THAT is where the success begins and ends.

So, when you are sent for your Psych eval, I would heartily suggest that instead of seeing it as a waste of time, think of it as another component of a successful LAP-BAND® experience….embrace it, and consider making Psychotherapy a part of the process of becoming a Healthier person. It might be the difference between success and failure.

Thank you Spartan for your insightful post, I actually didn't even have to go to my Doctor to get a Letter from him. He just wrote one for me. I do see him every month But Now I would really like to see a Therapist that specializes in Weight Loss Surgery so we can address my concerns.

After reading so many of the others post I can see how they feel like the Evaluation was a waste of time I think I will ask the Doctor before I go if we will be truly address Weight Loss Surgery or just filling out paperwork. Thank you, Spartan.

[RavenClaw779 2]

As part of the pre-assessment for my surgeon, I had to write an "essay" regarding why I wanted to have bariatric surgery. I grew up in a physically and emotionally abusive home where food was restricted as either a control or punishment and there was a push to always be perfect - appearance, grades, right college...

Writing that essay forced me to really focus on the underlying issues of my weight problem. Issues that I've covered over by being successful in my career, building my own family, not being like my parents - but never really addressed.

A commited behavioral health professional is a blessing even if your life seems in synch - one who really isn't skilled or in the profession for the right reasons can be damaging.

I've already started looking for a real counselor to help me work through the past - it sure won't be the gal who was only interested in ticking off the required items with her hand out for my check!

[ladykcusa 1]

Jax - your comments "struck a cord" with me. My step-father was a prisoner of war and had major food issues, understandably.

However, growing up I experienced severe punishment relative to food.

It never dawned on me that these childhood situations might still be affecting my attitude toward food.

These boards are very enlightening.

[bigbirney 3]

Jax - your comments "struck a cord" with me. My step-father was a prisoner of war and had major food issues, understandably.

However, growing up I experienced severe punishment relative to food.< /p>

It never dawned on me that these childhood situations might still be affecting my attitude toward food.

These boards are very enlightening.

I agree. I am one person that had a good psych consult. She grilled me on why I wanted the surgery, and what I planned on doing to change my mechanics of eating and my state of mind. I even had a follow up before she would clear me to make sure I would do ongoing treatment.

I am not like everyone, but my whole family was food lovers. After my mom died I turned to booze and food. This went on for years, and many pounds. Since then I have lost other family members, lost a fiancee after 5 year relationship, almost lost my father to pancreatitis. It just kept building and building inside of me, until I cried at every commercial, and would stop and multiple drive thrus. Basically eat myself sick every chance I had.

Everyone is not the same, and many doctors that do the surgery shouldnt, they see it as a cash cow, and instead of making sure your ready emotionally, they just push people through. Some succeed and many dont.

The way I was presented the surgery was: It is a major life change and stressor which added to already stress full and emotionally unstable situation can pose more problems that it can solutions.

Everyone has a different threshold.

Edited February 12, 2010 by bigbirney

[RavenClaw779 2]

Great article by Melissa Healy(LA Times) - Eating away at binge disorders - a must read!

Several quotes in her article really struck home with me:

"...Overwhelming feelings of sadness, anger or stress trigger episodes of eating unusually large quantities of food, often when she's not at all hungry..."

"...childhood traumas that may drive binge eating and other self-destructive behaviors..."

When I was going through breast cancer treatment (10 yr survivor!) I was blessed to be treated at the mayo Clinic. Their approach was comprehensive - whole body/whole person. I went through therapy and dealt with some of my childhood issues - apparently not as successfully as one would hope as I managed to gain 83 pounds in three years! Nevertheless, one thing my therapist commented on was that she was surprised given my experiences, I hadn't become an anorexic, alcoholic or drug user.

I often wonder how many of us out here battling our weight have been using food to comfort ourselves or stuff down our pain or loneliness?

[ladykcusa 1]

Stuff down pain and lonliness and self abuse for not being "perfect".

I had my first appt with therapist this morning. Will see her again next week and ongoing as I continue this life-changing journey.

Have "named" my band - My Hero. Life will be easier with My Hero walking thru with me.

[LeeSuh 0]

Hello everyone! :biggrin:

I have a question about the psych evaluation. I'm trying to find a Dr to make an appointment for my psych evaluation, the first place I called told me the insurance would cover it but I would have to pay out-of-pocket for the "report" ($150). My question for you experienced bandsters that had to do the psych eval.... what's the process? Do I really need a report from the psych? I thought it was a yes/no kinda deal? Is the yes/no a "report" ? Did any of you have to pay an extra fee? Can some of you share your experiences as far as the cost of the evaluation? Please?

I would ask my doctors office but because of the holiday they are closed today.

Thanks guys!

[LeeSuh 0]

Hello everyone! :biggrin:

I have a question about the psych evaluation. I'm trying to find a Dr to make an appointment for my psych evaluation, the first place I called told me the insurance would cover it but I would have to pay out-of-pocket for the "report" ($150). My question for you experienced bandsters that had to do the psych eval.... what's the process? Do I really need a report from the psych? I thought it was a yes/no kinda deal? Is the yes/no a "report" ? Did any of you have to pay an extra fee? Can some of you share your experiences as far as the cost of the evaluation? Please?

I would ask my doctors office but because of the holiday they are closed today.

Thanks guys!

[kagead 0]

Hello everyone! :wink2:

I have a question about the psych evaluation. I'm trying to find a Dr to make an appointment for my psych evaluation, the first place I called told me the insurance would cover it but I would have to pay out-of-pocket for the "report" ($150). My question for you experienced bandsters that had to do the psych eval.... what's the process? Do I really need a report from the psych? I thought it was a yes/no kinda deal? Is the yes/no a "report" ? Did any of you have to pay an extra fee? Can some of you share your experiences as far as the cost of the evaluation? Please?

I would ask my doctors office but because of the holiday they are closed today.

Thanks guys!

I think every insurance company and every surgeon is different, but both my Dr. and my insurance co REQUIRE the psych eval.

While it isn't as cut and dried as a yes or no in my program, the psych needs to tell the surgeon whether or not he feels I am a good candidate and whether or not I have realistic expectations of what I'll need to do to be successful. He needed to hear that I truly understand how the band works and what my own roadblocks have been in past attempts at weightloss.

As I stated a few posts down, my ins. only covers 50% of psych services so my out of pocket was about $125.

Best of luck as you work through this crazy process! :biggrin:

kagead

[RavenClaw779 2]

I would ask your surgical practice for a recommendation - they often know of psychologists who specialize in eating disorders. I'd also ask if you can use any provider you choose. See my prior notes on my experience.

I'm on the phone now w/BCBS as the psychologist who did my evaluation demanded payment up front and is now refusing to submit the invoice. Per BCBS she is an in-network provider and WAS NOT supposed to get a payment from me prior to submitting the invoice to BCBS. That said - every insurance company is different. Know your plan, check to make sure who you use is "in-network" and if you're not comfortable with something the provider is telling you re; your payment requirements , call your insurance company to confirm how you're plan works.