Friday, January 26, 2007

Still Stewing

[ranting by dinah]

I'm still stewing about ClinkShrink's comments about all those Worried Well folks out there. You know, the hoards taking up luxury hospital beds to get their adjustment disorders fixed, or using up the few precious resources available for psychotherapy by talking about day-to-day stuff. She made a comment on our podcast (oops, I didn't listen to it, but I might just to stew some more over this comment) about how if physicians don't ration psychiatric care, it will be done for us, it's coming, it's inevitable. Personally, I think Clink's been drinking the Kool-Aid.

I don't have "a" patient with an Axis One disorder whose symptoms resolved and who still comes but talks about day-to-day stuff. I have many. None, for the record, drink coffee with me.

Here's how psychiatric illness goes:

A patient comes in with complaints. Seeing me takes time, an outlay of some money, and hassling with your insurance company (no secretary, no insurance participation). No one, and I mean no one in over a decade of private practice, has ever walked in the door saying "I'm coming to talk about day-to-day stuff." No one has ever come to be self-actualized. Almost everyone cries. Everyone is in some state of distress and the vast majority of people I see are already on medications or will be by the time they've seen me a few times. Some people aren't, and maybe they want to work on something concrete-- something like a tormenting marriage, or the fact that they are pre-occupied to the point of great angst over a former lover stuck in their head (sometimes for decades) or an ongoing or acute stress in their lives. It's okay if these folks get help even if they don't have a major mental illness?

So, the majority, the gang we all agree deserve care, those Axis I folks, they take some meds, they talk (generally about the day-to-day stuff going on in their lives) and most of them get better, soon. Some still come for a while, until they're sure that the better holds (it doesn't always), or because they don't get all the way better and the symptoms fluctuate, or because the talking lends some comfort in a life where things are difficult. Carrie, summed it up when she said about meeting with her psychiatrist when she's not in acute distess, " If I do not continue to work with him in the way that I am at present, then I believe that I tend to fall very quickly back into my own depressions." I couldn't have put it any better.

This is the deal, the newsflash: in psychotherapy, everyone talks about the day-to-day stuff going on in their lives . They talk about what's happened since they came last. They highlight the trouble spots. Some relate current events to past patterns. Some are more interested than others in talking about their childhoods. Sometimes, people talk about the routine-- I've commented before on a (confabulated, of course) patient who talks about the price of beef at various stores. That patient is on 4 psychotropic meds having tried many others, a couple of hospitalizations, and the last episode of illness lasted many months with many, many awful symptoms. If talking about the price of beef helps, that's fine by me. And trust me, if you met her, you wouldn't for a moment question her right to access psychiatric care.

Why should suffering be valid for discussion only if your distress can be boxed into a Chinese-menu DSM box of symptoms? Why is should it be okay to access care (where you'll talk about day-to-day stuff) if you have a mental illness, but not if you're just miserably suffering without a disorder as designated by some committee? And if you feel that talking is helpful, or perhaps prevents relapse (and why is that??), then why should it only be valid to come for therapy if you're hurting at this very moment? What if you were hurting yesterday or might hurt tomorrow, or just want to tell the doc you're doing better?

And to those who've suggested (or demanded) that patients should see non-psychiatrist mental health workers for psychotherapy and psychiatrists only for meds: Why? What if the psychiatrist wants to see patients for psychotherapy? What if the patient wants to see a psychiatrist for psychotherapy? I'm not saying everyone psychiatrist must do psychotherapy, nor am I saying that someone who wants to see a psychologist or social worker shouldn't. There are plenty of psychiatrists who are still interested in psychotherapy and some of us who don't find seeing four patients an hour to write a script based on a minimal amount of information particularly fulfilling as the only aspect to a career. I'll do a post later on split treatment in public settings -- I tend to blog from my private practice hat, but I work in a public clinic as well.

There are plenty of patients out there with severe mental illnesses who don't keep appointments and therefore waste resources. There are many who refuse to take the prescribed medications, whose own behavior results in repeated hospitalizations at great cost to society. They are the very ill, certainly the rightful recipients of our care, but we don't have an efficient system to define and weed out exactly how much care who should get from which professional and what it's okay for any given patient to talk about.

While I don't believe that society (meaning government-run clinics, medicare/medicaid) owes every person who wants it unlimited psychotherapy with a psychiatrist, I do believe that the definition of Patient-hood lies with the patient. And I don't share Clink's pessimism that this will lead to an overload on the private insurance system and more regulation is to come: Managed Care has been a dismal failure and the pendulum has already started to swing the other way.

Clink (who has posted simultaneously, see No Retreat) seems to think it's one pot of money, and if one guy pays his way for top-notch care, another guy suffers. We have universal education (sort of, think of all those children left behind), yet many people opt out for private or religious education, paying out-of-pocket. That, I believe, is similar to getting care at any private venue that allows one to pick and choose, to ask for what on perceives to be The Best.
Okay, I'm done ranting.

Roy, where's the new picture of our feet?


ClinkShrink said...

Regarding: "It occurred to me that you *should* have a telephone. And you should have more staff. An assistant who works on organising follow-up plans, perhaps. While you personally are doing all you can with the little you have, shouldn't you have more?"

Bless you bless you bless you bless you

Thanks Alison and yes you're right. In corrections we only get more when someone files a class action suit. Then loads of money gets spent on lawyers, expert witnesses and court monitors to get a fractional increase in services. According to my colleagues in the UK this class action business just never happens. Correctional health care is defined through the NHS and is budgeted along with everything else.

Midwife with a Knife said...

Again, I think it's the DSM that may be limiting you. Shouldn't anything that causes serious suffering or difficulty with functioning be defined as an illness? Especially if it can be treated? I think that includes someone's tormenting marriage or persistent thoughts about their ex for years. If you call it an illness, it's easier to justify care.

Tangentially, why does psychotherapy/talking help? I don't know much about psychiatry, really. The only real psych disorder I treat is postpartum depression, and if someone has severe postpartum depression, suicidal ideation, or psychosis (or if they would prefer to see a psychiatrist) I send them to a psychiatrist, and sometimes I wonder if I should try to treat it at all, or if I should just send everybody to a psychiatrist (because I'm sure y'all are better at this than I am), but these people get better, and I enjoy treating them (in my own extremely limited way), so I'll probably continue to do so.

But anyway, I know the literature says that psychotherapy helps. It just isn't quite clear to me why it does. Maybe it's not clear to me because I don't do psychotherapy ("Tell me, how do you feel about your vagina?"); but I've always been curious, why is talking about the price of beef helpful?

DrivingMissMolly said...


First, I want to say that if you automatically referred to a psychiatrist, some of your patients might not go, so in that sense it is probably good that you take those postpartum issues into your own hands.

Secondly, although not a therapist or psychiatrist but a patient, I find your question intriguing and am going to attempt, in my own way, to answer it.

It isn't as straight forward as "tell me about your vag," or "why do you wanna talk about beef." It's what's behind the vag and the beef. There is always something behind the curtain and sometimes it ain't pretty.

I'm going to use a couple of examples from my life. My diagnosis is major depressive disorder and borderline personality disorder. I also think I have generalized anxiety disorder.

According to Marsha Linehan, the creator of dialectical behavior therapy which she specifically created for "borderlines," one characteristic of a "borderline's" childhood is frequently INVALIDATION. I'd say I didn't feel well. I'd be called a liar or that I was exaggerating or trying to get out of some task. I was frequently referred to as "stupid" despite stellar grades. My feelings did not matter to my family at all. I was physically abused, including getting slapped in the face and hit with a belt. I recently learned from my sister thatI had welts on my legs but I don't remember that. Personally, I think that being slapped in the face is not just humiliating but invalidating as well, so I believe the physical abuse + the emotional abuse just exacerbated everything.

Enter therapist. When I told him all of the above, and more, he said; "I am so sorry." I said "Why are YOU sorry, you didn't do anything." He said; "I want to tell you that what they said and did was wrong and I am so sorry that happened to you and that they did that to you."

I tried to play it off like it was no big deal but it was. He had just done what Mommy, Daddy, sibs and ex-hubby never had done, he VALIDATED my feelings. Someone who was not in any way responsible for my pain and for my past just apologized to me. Not because he felt sorry for me, like I was a pathetic loser, but because he CARED enough to try to right a wrong.

The power is in the interstices, Midwife. In between appointments when I think about things I've said or he's said or what I didn't say. In the silence between sentences. When I am alone at home and thinking and feeling.

It's powerful stuff. It is birthing a new person from the wreckage.



Dinah said...

MWAK: great question. I've no idea why talking about the price of beef helps, why it helps some and not others. Really, it's about the relationship, and that will be another post. Lily describes this better than I ever could, this was great! I say "I'm sorry" in therapy all the time. It's not an apology in any way (I didn't cause the circumstances, I'm not apologizing for them)-- it's a statement of regret that the patient is distressed or has been through something awful. I hadn't thought of it as a validation, but that's a great way of putting it for those who've felt invalidated. Sometimes, even us shrinks don't know what to say and "I'm sorry" is a bit of "I'm listening and I hear you're uncomfortable." Hoping it's a blast of sympathy...

Moving on, I'd be all in favor of allocating more resources to the mental health of prisoners, it would be money well spent.

If it helps one person stay out of jail (at how many tens of thousands of dollars/year?), hold a job and therefore need less from the taxpayer and actually be a taxpayer, be there for his kid who would then need less services down the line...

Money well spent, just the benefits to society --including the criminal, his family, the taxpayer and any spared potential victims. It would be 1) down the line 2) expensive to prove --but far from impossible in a captive audience and 3) not everyone would benefit, cause that's the way it is, guys.

You should have a phone and a computer. You should have a comfortable working environment with a lot of vacation time and good pay; clinician safety should be paramount; you should have access to free coffee and (chocolate) donuts: these are things that make a work place pleasant, that retain psychiatrists and make it possible to recruit new ones easily. You think I'm kidding about the donuts, but I'm totally serious: as someone who was once a resident, as a former clinic medical director, as a Jewish mother: Feeding the staff is crucial. You all joke about sitting on buckets, 90 degree heat, no phones, thousands of patients/year, years with no vacation: the jails are lucky to have Clink, but there aren't many of her to go around.

I'm all in favor of increasing mental health resources for prisoners.

Alison: I still doubt that anyone is buying inappropriate services. I believe the patients in those units are mentally ill and simply opting to self-pay for a higher thread count on the sheets.

Maybe we shouldn't compare healthcare to education (hmmm, why not? maybe because certain public systems are horrible, others are wonderful...we hear about the lousy ones....and I believe all three shrink rappers had public high school educations).

We live in a capitalist society: Everyone should also be entitled to eat (what good is healthcare if you've starved), but not many of us would say that the government is obligated to feed the poor lobster newburg for dinner each night. Nor would we begrudge the rich guy who wants to buy it for himself (okay, maybe we would begrudge him, say he's just worked a 12 hour day and wants to use his salary for lobster, is that okay?).

The fact that Joe Rich pays out of pocket for a massage as an inpatient doesn't raise the cost of care for Tom Poor. And if you want to dictate that all psychiatrists must practice in a certain way to maximize the number of people they can see, even fewer docs will become psychiatrists.

Damn, I'm still ranting.

Patient Anonymous said...

Wow, this has gotten kind of interesting. I sort of stayed out of it because of all the talk about allocation of resources in the US etc... and being in Canada, well everything is covered, alison mentioned that.

But regarding the issue of psychiatrists actually practising therapy, in my experience, that is rare! I've never had an ongoing relationship with a psychiatrist (but it looks like I soon might?)

The ones that I have seen have just dispensed meds in a brief consult and that's that. Don't let the door hit you on the way out!

I've had to satisfy my therapy needs elsewhere. There was absolutely no time for any discussion of any "personal issues" with my previous psychiatrists. Unless I was in acute distress then I might be able to squeak something in. The concept of actually speaking about personal issues (as opposed to medical, pertaining to my diagnoses etc...) to a psychiatrist is a completely foreign concept to me.

I don't know if this adds anything but I thought I'd post it anyway. Perhaps that's one reason why I've had an aversion to seeing psychiatrists for so long!

HP said...

Have to agree with PA.

Dinah, you'd be a rarity in my world. I mentioned previously that 90% of the psychiatrists I have referred to assess and dispense meds. only. None have chosen to perform psychotherapy themselves. Some have opted to work in a shared care arrangement with us which can work well.

Let me describe a psychiatrist appointment as described to me by a patient.... 'I entered the room, he was sitting at his computer, he barely looked up, asked a few questions re. symptoms, side effects, meds, produced a prescription, suggested an appointment in 6 months, grudglingly answered a question and dismissed me...all the time barely looking up'. The patient was quite distressed by this.

Most definitely an extreme example and we ultimately referred to a new psychiatrist..although, again, no psychotherapy.

Believe me, I'd welcome referring to a psychiatrist such as yourself, someone who preferred to take over total care. Less disjointed for the patient, more convenient to juggle one appointment schedule rather than two. The reality is, it just hasn't happened.....yet.

DrivingMissMolly said...

It wasn't until quite recently that I found out that one reason psychiatrists only do med checks is because of managed care. That is, managed care says that the patient can get psychotherapy from a cheaper provider.

I also read somewhere that it is more lucrative for docs to do a bunch of med checks in one hour than do therapy!

I too was rushed in and out of psychiatrist offices for YEARS, spending 5 to 15 minutes with the doc even, for the most part, as an inpatient!

I wish I could see my psychiatrist for therapy but at $190 per hour, that is beyond my financial reach. Besides, I have been seeing my therapist for almost three years now and it is free because of where I work.

When I see new shrink, it is about a one hour apointment. I am not sure why since his answer to almost everything is "that's something for you and your therapist to work on."

WTF? Do any of you shrink rappers have any idea why he sees me for so long?


Sarebear said...

I didn't know you could cook!


NeoNurseChic said...

My psychiatrist did psychotherapy as a resident, but now that he's a fellow, he only does clinic one day a week. What's weird is that, to tell y ou the truth, I don't know if he still sees patients for psychotherapy or mainly just does medication management on the clinic day. Now I want to ask him. And also, on Wednesday we discussed his future plans, and he'll be doing mainly hospital work at his new location, but will see a few outpatients. Since he is a geriatric psychiatry fellow, I assume that he'll be doing geriatric psychiatry inpatient things, but I also didn't ask him that either. I will continue to see him, although maybe the frequency and pricing will have to be different.

When he took on his fellowship, he said that I could continue to see him with the same setup we had going. That's why I don't know what he does on clinic days and so on. I still get to see him for my 50 minute hour whenever I have an appt.

Why does psychotherapy help? Geesh - that's kinda hard to put into words, and I imagine that no two answers are going to be alike. The reasons it is helpful for one patient are probably different from the reasons it is helpful to the next. I find that for one, it is easier for me to talk to someone who is objective and not involved in my daily life outside of being my psychiatrist. I can tell problems to my friends, but eventually they're not going to want to listen and they might just stop being my friend altogether. They might listen to my problems and respond in a nontherapeutic way. They might tell me that yeah, my fear that I'm a bad person is true - they have no obligation to listen and respond in a productive, therapeutic way.

On the other hand, I'm paying my psychiatrist to do just that. Part of me, this very teeny part of me, thinks about that and cringes...."I'm paying someone to listen to my problems because that's pretty much the only way I can find someone to listen to them..." But that's certainly not the only reason! He does manage meds for me, but mainly we do therapy. We talk about my life, my thoughts, and mainly I would say that we work to understand them. Not to fix them or change them, but understand them.

I have been changing my entire life to fit into other people's wants and needs - that has been how I've lived forever. Always wanted everybody to be happy, even if it meant I was miserable. So now I'm trying to figure out who the real me is...get her out of the closet, so to speak. That's hard to do - if it was left up to me, I'd continue along the way I always have....filling my minutes and hours with so much busy-ness that I don't have time to stop and think about how I feel about it or whether or not I am happy. Sometimes I revert back to my old coping skills. I would have to say that the fact that I have quit school and don't really have a lot of activities going on right now is a testament to my moving forward, if anything. I can now spend hours alone with my thoughts, and not lose my mind. haha

Now - part of it is learning to cope with major medical problems and the fact that my life doesn't fit the picture of what most 26 year olds are doing. Part of it is learning to cope with depression and what to do when I just can't handle it...learning that when everybody else throws their hands up in the air when I get that depressed, that he actually will still be there to help. And learning to trust that - instead of expecting that he'll throw his hands up in the air, too. And part of it is learning why I get so anxious all the time....this conflict inside me regarding something....this anxiety comes from somewhere - and instead of burying it or snapping a rubberband on my wrist to try to get myself not to worry needlessly so darn much, we are working to understand why that anxiety is there in the first place. The biggest problem is that for me, I have a hard time saying it out loud - I might have the thoughts race in my head, but I can't grab them to say them out loud. But I think in learning about what makes me so anxious, I might just learn how to deal with that anxiety and how to bring myself out of it a little bit easier.

As long as that is, that's a very simplified explanation of some of the reasons why I find therapy helpful. I think there is a lot behind the quote that Dinah put in the post - since that quote is what I said. I had been talking about the fact that if I didn't continue on with therapy the way it is, then I would fall back into my more depressed state. I truly believe that one of the things that gets me through is just having the appointments at all. I know that on this date, at this time, I can talk to someone who will listen to me and at least on the outside, care about what I'm saying... (This issue of paying somebody to listen and care is really bothering me tonight for so me reason!! I did just get home from my appt a bit ago...wonder if something from that or my mindset from all this is what's making me go there with my thoughts!) So say tomorrow something terrible happens - not something physically terrible to me or just to the world - but say something personally terrible happens.....some bad social situation or somebody says something very upsetting to me or something happens with one of my family members and so do I get through that? Well...I know that as bad as that thing might be, I have an appt on Tuesday. So I can make it to Tuesday. If I didn't have that appt, then I might just let that one thing eat me up and destroy me... That sounds childish - plenty of people go through bad things and don't need a psychiatrist - but I don't think it is a weakness to need help.

The difference between the 3 week period where I didn't see my psychiatrist as he transferred from one university to the other and the 3 week period where I went to England and then he went on vacation one thing. In the former situation, I had no appt set up. Nothing finite. No planned time when I would see him again. I could call this one woman at the old university, and she would know how to reach him, but otherwise - nothing set up. So when things started to get really bad for me, I felt completely alone. I felt desparate. I felt like everything in my life was black and I was falling into a hole. But then when I had the latter situation - actually leading up to that, I was petrified that I would have a major relapse into how bad I was in the summer. But I didn't. And the reason why is because I knew I had my appt set up for once he came back. Over New Year's, if I hadn't had an appt set up for after that holiday, I would have lost my mind....I think I would have gotten so much more down and depressed - but I had something - so I knew there would be a point where I could talk about what happened. So just the thought of having my date and time makes me feel better.

This whole conversation and topic is helping me to stay distracted from my current blog issues. Thanks. :)

Take care!
Carrie :)

Dinah said...

It's a city thing, I believe. If you're in New York, Boston (where I hear all you have to do is toss a stone and you hit a psychoanalyst), or any other major US city, there are lots of psychiatrists. Rural Alabama may not have the luxury of shrinks who listen, but I've never been there.

I went to the Doc Finder of the Maryland Psychiatric Society and did a member search for Psychotherapy (ie shrinks who do, no other restrictions): it popped back 192 names of MD psychiatrists who'd listed "psychotherapy" with their areas of expertise. I forgot to see if it included Clink or Roy. And there are lots of shrinks who aren't in The MPS.

Roy, why haven't you joined in the fun here? Too busy castrating iguanas, I suppose.

DrivingMissMolly said...

Gosh, Carrie, I can relate to so much of what you are going through, the anxiety (Xanax worked great for me, I could capture one thought at a time), quitting school, fearing the return of the "black hole" of depression...but, we're different.

I sort of dread therapy appointments even though I am glad I go and I like my therapist. It is hard for me to think differently.

I felt, before my diagnosis of borderline, that there was more wrong, something "foundational."

The horrifying reality is that I don't know who I am. I am a ghost in my own life. I'm not sure about much of anything. I generally don't value my life. My first shrink 17 years ago said that somewhere I got a message "not to be."

I feel like a bomb that is set to go off but I don't know when and I am trying to difuse it.

Inner conflict and ambivalence rule my life. I like thinking of ways to die because it seems like it is supposed to happen.

I want Dr. Shrink to fix it. It's like I KNOW he has the answers but he won't give them to me!

I have serious problems with the way I relate to the world, BUT, I think I have something to offer it, maybe?


Anonymous said...

I'm in the UK, I'm bipolar and have found psychotherapy problematic. I have had a range of therapies from psychodynamic through Rogerian counselling to CBT. I have had what was described simply as psychotherapy with two doctors on the NHS, one a retired general practitioner, and one a psychiatrist.

I wasn't totally impressed. It seemed a very long-winded way of sorting out problems, and I would rather the NHS had put the same amount of money into some practical rehabilation. You can sit with someone and talk about isolation, or you can go with them to the gym or a club a couple of times until they feel ok to go. I'd prefer the latter. I can sit and tell a doctor about all my psychotic and suicidal thoughts, but that won't get me a job or a home. I can be taken to see him and tell him I can't cope with shopping or getting my medication, but his listening to me telling him doesn't put food or medication in my belly.

If talking therapy is what's on offer, I prefer practical stuff like CBT, or straightforward listening by the Samaritans (our version of Befrienders).

But on the NHS, you don't get to choose what sort of therapy you have. The therapist doesn't even tell you what sort of therapy they practice or how it's supposed to work. And you don't get a choice of gender.

I'm not knocking psychotherapy for those that want it and find it helpful, but I prefer my psychiatrist to do the stuff he does do, like writing letters to people to get me back into university and into a new place to live and writing to my GP to ensure I get the right medication. The Samaritans can do the listening as and when I need it.

Fat Doctor said...

Dang, woman! I haven't been able to read my favorite blogs all week because of time constraints. I settle in for a happy night of web roaming and you're all hot & bothered. I love it!

Your arguments are good ones. I personally don't feel warm and fuzzy about the separation of psychiatry and psychotherapy. Meds are good, but they aren't a cure-all.

I just came from Laughing Pastor's blog, which is becoming increasingly feisty, and I think maybe the two of you should get together for a cup of coffee!

HP said...

It's a city thing, I believe.


Can't really apply that explanation to here. Sydney is, by Australian standards, a pretty substantial city.

Maybe it's a cultural thing. Perhaps in view of the good working partnership sometimes found, we have a closer integration of our mental health professionals.

I believe that's a good thing. We offer different and often complementary things and I think that's important. Ultimately, it should be whatever fits best for the patient.


ClinkShrink said...

I just wanted to drop a quick note to thank all the non-U.S. folks for their input and insights. It's always been a little frustrating to know that so many non-Americans read the blog but few comment; I like hearing how the rest of the world lives.

Dinah said...

Sarebear: I cook.

HP: Maybe a US city thing? Oh, there have to be MD psychoanalysts in Paris (?!?) but my Shrink experience is limited to the US. I, like ClinkShrink, love the international input.

Anonymous said...

Speaking of psychiatrists and therapy, why is it sooooo hard to find a psychiatrist who even does therapy any more, at least in some parts of the country? We moved back to Va 3 years ago and I have yet to find more than 3 or 4 MD's who actually do the "talk thing" is very discouraging, since I left behind in Ct a very kind, caring excellent psychiatrist/therapist....can anyone out there help me...? I live in the Richmond area, but am willing to travel, for the right doctor....thanks, tb

Anonymous said...

I just wanted to thank you for the follow-up post, Dinah. I am convinced.

(I wrote a comment to you first post saying that the "Worried Well" ought not to have access to psychiatrists. My impression from your original post was that these were individuals who knew that they had no psychiatric disorder, and were not going to develop one. Now I see that this is not what you meant at all.)

Steve & Barb said...

TB: you can go to the Psychiatric Society of Virginia website and you will find their email address for referrals. They can help you find such a doc.

Patient Anonymous said...

Not unique to urban or rural areas in Canada, I don't think. Not being a health care provider (psych or otherwise) I just think that psychiatrists that actually engage in therapy are exceedingly rare!

I did meet a man who was seeing a psychiatrist who also was a psychoanalyst. I thought was interesting. I just needed a med consult and to address some other "issues" that were strictly head/behavioural (my ADD and what not but basically--all meds.) I called him. He (even though he was a psychiatrist, could medically prescribe and all of that) thought that I was a little "too complicated" and "might want to see a psychopharmacologist" because of all of my other comorbidities.

WTF?!?! It's called Concerta or Adderall (or maybe even the Boogeyman drug can work...) Will I benefit from any of the above and do you think there's a chance that stims will make my brain do flip flops (yes, that is the accurate medical and scientific term) because I have Bipolar. Even though lots of other Bipolar people take it for comorbid ADD too. The key, I believe, is to ensure that I am stable and use a slow and steady titration. Not to mention that adults need lower amounts of the drugs than kids and it's proportional to body weight. And yes, feel free to re-assess me if you absolutely must.

This is what I have to look forward to in the near future. I'm hoping that the two docs won't be too horrid. I hope I don't sound too horrid but really! Can't we just sit down and get to the bottom of things and for once not be so dismissive, doctor? Please?

*waves south to clickshrink*

Patient Anonymous said...

Oh dear, apologies for bad typos and not waving to Roy and Dinah as well. They need to put idiocy in the upcoming DSM-V...or maybe, bad idea.

Anonymous said...

Obviously, I am late in the game here, but WOW....can't believe what I am reading. My brother was a psychiatrist who practiced psychotherapy, I go to a psychiatrist who practices psychotherapy and I know many psychiatrist's who have successful practices in psychotherapy. Granted, I am in Austin, TX. Maybe we are behind the "times" here.
What does the price of meat have to do with a patient's problems? Everything, if you believe in this person having a "safe place" to talk and disclose the true self. I would immediately wonder if countertransference was showing that this person could possibly seem boring to others? Maybe bored with their self? Maybe hiding behind mundane things? Denial? Learning to socialize? Meat can take you to many places....LOL.