No psychiatric evaluation approval

You can't really take an assessment "wrong."  If you try to take it a certain way it can skew the results.  It isn't your fault.  They may be biased.  More on that later...

First, a disclaimer: normally I try to remember I am not a clinician here.  However, this may be of use.  It's not meant to be annoying - I just tend to be matter of fact-ish.  At any rate.

This individual may not be a clinician with anything against bariatric surgery.  They may simply know little about surgical assessments.  The only people trained to do surgical assessments are those of us who seek out this training, and psychiatrists.  This includes the highly vaunted PhDs.  Regardless, your first question must be, "how many bariatric assessments have you done?"  Your second: "what assessment tools do you use and why?  Do they meet ASMBS requirements?"

First of all, if you are worried about clearance, get a psychiatrist to do the assessment - preferably one you have a relationship with already.  Don't bother with a psychologist.  Most insurance is fine with a social worker or licensed counselor doing them, however, most doctors give the most credence to other doctors.  That's just how it is. It's the mental health equivalent of washing your car with a power washer, but it works.  If you have a history of depression and anxiety and no current counselor, I always suggest going to a psychiatrist for a referral.

If healthcare providers have immediate appointments and they are not due to cancellations that means their practice is not busy.  We need appointments to make money.  My counselor routinely has a 2-3 week wait if you aren't on the schedule.  If we are not busy we are: 1) new, 2) just come off maternity leave/other jobs/back in the workforce/or are an integrated HC clinician whose main focus isn't building a case load, 3) crappy.  #1 isn't a problem.  #2 is probably not a problem, but makes me wonder about their clinical insight if it's been a while.  I probably would give them a shot.  #3 should give you pause.  Bear in mind this is just a general guideline.  However I pack my case load full if I can because I get no income for no-shows.  Unless they are salaried, that is, they work for a hospital or gigantic company, they must make money one-on-one, which means they must pack in those clients.  It's the reality of the business.  Just something to contemplate.

When I do any evaluation, particularly a surgical evaluation, this is what I look for:

1) Honesty - lying or downplaying I will note.  And yes, I can tell when people withhold information, especially when you are omitting things already in the file. 

2) Pathology - mental illness that is untreated.  If it's treated, as long as there is no psychosis or cognitive difficulty in maintaining compliance post-operatively, we actually don't necessarily care about this.

3) I am going to be blunt because I am a blunt counselor.  "Issues" - first of all, unless you are under 1-2 years old, you have issues.  Everyone has issues. I have issues.  If you are obese, you have issues.  These issues contributed to a BMI significant enough to require major surgery to remove and/or permanently alter your digestive system.  By the way, there is nothing wrong with having issues.  I have truck fulls.  I have so many issues I probably have a storage unit of damn issues I forgot about.  There is nothing wrong with that.  I mention this because, even if its not on your psych evaluation, my job is to determine why you are obese.  

If you tell me you don't have issues, I will probably not believe you, because every one of the 100+ clients who started therapy or an assessment by telling me they have no issues has, at a later date or even in the same session, told me about their issues.

Hey Donna,
Thanks for your reply. As i stated in a reply up there, I did regret saying " I don't have issues" as we all do as
none of us are perfect. I just didn't expect her to hesitate on a clearance of this sort.
She is in a very small private business with counsellors and after we had talked a short time she kept hinting that she would
like to have me make appointments in the future because she thinks I have esteem issues regarding alopecia i've suffered
over 20 yrs. She also thinks I may have adult ADHD, to which she suggested again that we continue to meet. She reminded me again
that I should think about booking an appointment to discuss things because "everyone can benefit from therapy". At which point she stated that
she would approve me for bariatric surgery though because everything else was "unrelated".
It wasn't till I had been waiting 2 weeks and hadn't heard anything from her company or my surgeon's office and I call her back and she say's she
was conflicted about my bariatric clearance and that I should come in and we talk some more for her to approve me.
This was the point where I was confused and honestly a little skeptical as to whether they just wanted some more billings.
I will see a liscenced psychiatrist now. But i'll also go back to her on my next appointment on tuesday and see what she says then.

It sounds like there is a lot of confusion.  Hopefully it will get sorted out!

As for adult ADHD, ask if you should get a neuropsychological evaluation, then.  I can diagnose ADHD, but often I will consult or refer for neuropsych assessment to be sure.  It is tricky to diagnose in adults, as there are many things that can confound this observation, and I consider it good practice to consult a psychiatrist or psychologist for assessment.  The psychiatrist will be able to assist - and even if it is ADHD, you would likely need to consult them for treatment, anyway.

I actually don't know that everyone can necessarily benefit from therapy.  Some people do not have the cognitive capacity to do so.  Others are not open.  We only get benefit from therapy by being open.  I tell every client the day we meet that my goal is to get them to a point where they no longer have to pay me.  That is my job - period.  That doesn't mean I kick people out when they need help.  It does mean I have a pragmatic goal in mind that we work on together.

I can give someone the entirety of my education and it will do no good if they do not put it into practice.  Therapy was humbling for me, because I had to dismantle my life brick by brick and rebuild from the foundation up.  I am very glad to have been in counseling for many years, and I consider it a personal mandate to do the same for others.  However, it is not an easy process, necessarily.  It requires a willingness to see what we don't want to see, to be wrong, and sometimes, to be broken so we can reset the mental limb to heal.  It is difficult, if worthwhile.  

Hate to insert into someone else's convo, but my primary care physician told me the same thing as you Donna about adult ADD. She can be reasonably confident in her diagnosis, but would need a consult for a confirmed diagnosis. For example, she said some symptoms of anxiety can mimic ADD.

The only reason it came up, is because I was googling to find a study I had heard mentioned in the news regarding a possible link between ADD and obesity (I was interested in learning more about impulse control but didn't find it) then I ended taking an online quiz, which I thought would be silly. I Answered yes to all but one question! It was literally like they described my life! Then I did another. And another... So I brought it up to my Dr. she told me the above about other conditions with similar symptoms etc , gave me another longer questionaire, which was a scaled one. Even she was like, huh. That's pretty obviously skewed to yes. 

All that to say, as you and hala mentioned, this whole process has been humbling, to really look at your choices and how you got where we are. But it's also been very empowering! To see things that I always considered character flaws in myself as something that is actually manageable, reinforced my belief that we never stop growing and learning, if we want to.

Even in kids it is complex, actually, because so much can mimic it.  I can legally diagnose it for sure, however I consider it what we call "standard good practice" to have further assessments done, because it is my job to do the best I can for my client, and because I definitely need to know myself before we proceed together.

I actually think there is a strong correlation between ADHD and obesity.  Part of the reason stimulants work well for binge eating disorder is not the appetite suppression but the fact it causes us to stop self stimulating.  There is a very similar method at play for both BED and ADHD.  The difference is that one is often caused by trauma, and the other is neurological - though, our understanding of THAT changes every year, too, science-wise.

ADHD/ADD means the individual needs constant stimulation.  Stimulants help with that by regulating dopamine.  Also, once we know as counselors, we can use particular techniques and teach skills to help with stimulation, too.  Someone with ADHD/ADD benefits hugely from just doing new things constantly, for instance, especially once it is controlled through behavior or skills or medication (or a combination).  It seems like a paradox but it makes a lot of sense too.

Even in kids, though, the majority of the time is they are simply under stimulated so they act out, eat, etc.  It is because they need input.  It is absolutely NOT a character flaw!

Thank you.  Love that part. 

3) I am going to be blunt because I am a blunt counselor.  "Issues" - first of all, unless you are under 1-2 years old, you have issues.  Everyone has issues. I have issues.  If you are obese, you have issues.  These issues contributed to a BMI significant enough to require major surgery to remove and/or permanently alter your digestive system.  By the way, there is nothing wrong with having issues.  I have truck fulls.  I have so many issues I probably have a storage unit of damn issues I forgot about.  There is nothing wrong with that.  I mention this because, even if its not on your psych evaluation, my job is to determine why you are obese.  

To add - i am not even remotely qualify to assess anyone. But when i see an MO person who tries to tell me that the ONLY reason they are MO because they love food and eating - I know they are lying to themselves... To get as big as some of us have - metabolic issues and psychological issues are often go hand in hand. 

The WLS can help with some of the metabolic issues... As long as the person does the rest of the work. 

Well, the reality is we are typically not super morbidly obese (or morbidly obese) unless we are overeating.  It is extremely rare that it is caused by only a biological issue.  The problem is that health and behavior have a reciprocal relationship.  Doctors are now starting to get it, and counselors are starting to get it, however many people practice in a bubble.

And issues are the side effect to living :)  Anyone who has lived a life is going to have some!  There is no "perfect" life for any of us, whether wealthy or poor, whether American or Canadian.  Living brings both joy and sorrow.  That's just a part of the human condition.

If she wants another session that is beneficial, I feel, and not a flat denial.  You are entitled to a copy of your assessment, as it is a part of your healthcare history, and you are also entitled to get her to explain what is going on.  I would definitely explore it further for your own peace of mind to see if it's a valid, or invalid, response on her part.

I would encourage you though that it is absolutely NOT the end of the road.  Also she should have never told you that on the phone, IMO.  I would have told the client during session to schedule a second appointment for us to review the results.  We all have different approaches though.

Even psychologists, whom everyone seems to adore, use entirely different tests depending on each.  There is no uniform bariatric assessment, as many of you know.  This is why we must all advocate for ourselves.

Thanks again