Thursday, March 22, 2007

The Blogging Shrink

In the comment section of ClinkShrink's Max & Me post, some of the commenters have started a discussion about what it is one does or doesn't want to know about one's shrink and what it might be like to read the blog of one's very own shrink. I've been thinking about this for a couple of days now, and I thought I'd turn my response into a post.

For those who haven't been here since the beginning to hear about my blogging angst, I started the blog last April after feeling a bit overwhelmed by the winter. I'd returned in November from a brief time in Louisiana with the Katrina Assistance Project, I had a bunch of patients who'd been having problems, I was feeling demoralized with my lack of success in getting my novels published, and I wanted a forum to express some of my thoughts -- more about psychiatry but a little about my own life-- and I wanted to engage interested parties in discussion about topics in psychiatry. My field, it seems, lacks consensus on much of anything, I'm not always very comfortable with uncertainty, and it's fun stuff to discuss. For me, a lot of it is about the writing. I asked ClinkShrink and Roy for help, and have been thrilled that they embraced this project with so much enthusiasm and investment. One of the best things about Shrink Rap is that my friendships with both of these wonderful people have grown, both on-line and in Real Life. Shrink Rap is now a part of my life, it occupies my thoughts in a stimulating way, I love the discussions we have here, and I've enjoyed "meeting" the readers who engage us in both intellectual and entertaining conversation. The blog has been a really good thing.

When we began, I debated using my own name, and initially used my full name. ClinkShrink and Roy were clear on the matter-- they were using pseudonyms. Though, as time and the My Three Shrinks Podcast have moved on, they are both aware that anyone who wants to figure them out, can. I had already published a novel, I'm very active in our local professional organization, here and there I've had a non-fiction rant published that people comment on. In the psychiatric community, I'm not particularly low-profile, and anyone who really wants to Google me can read about my thoughts and my life in a variety of forums. So why not? --and our blog bears my first name.

I've been proud of Shrink Rap. I ask my friends to read it, I mentioned it in our family Holiday card, I tell other shrinks, I have the URL on my C.V., even my big brother subscribes. I am who I am, and with my name plastered to it, I'm happy to talk about my thoughts about psychiatry, to let the people I know in a bit on my emotional life, to rant, to be a little sarcastic (couldn't we call it Witty?), to be playful and have fun. Some of it's a bit intimate, but nothing here is terribly personal-- aside from the dog Max and his friend Tex who have been mentioned by name and pictured-- I keep anything I don't want the world to know off the blog. The fact that it holds my real name serves as a constant reminder that I'm accountable for what I say and to me this feels right. A bit of writer's narcissism mixed in as well.

So what about my patients? This has been a complicated issue for me and it comes to life again as readers comment that they would be distressed to know so much about their shrink. Ultimately, in my life in a variety of roles-- wife, mom, dog owner, shrink, novelist, ranter, exerciser at a gym where some of my patients go, grocery shopper, restaurant patron, and the list marches on-- I've been left with the "I am who I am" conclusion. I suppose I'd rather my patients didn't read my blog, mostly because I don't want to upset anyone, and so far I'm not aware that anyone has. I don't tell them I have a blog (or a novel for that matter), and it doesn't readily pop up by googling my name. There are actually a bunch of people with my name out there and for the record, I'm not a dietitian in Dallas.

In the office, I offer little about myself. I wear a wedding ring, but don't have photos of my family. I offer little about myself for two reasons: psychotherapy is about the patient and everyone is more comfortable (me especially) with some boundaries in place. A handful of patients know about my novel, a few have read it. The novel makes Shrink Rap look like a fairy tale and has been a bit upsetting, I believe, for the patients who've read it. I can't, however, come to terms with the idea that I shouldn't write, or should do so only undercover, because it might upset my patients. There are many things in life that psychiatrists do that would upset their patients, I suppose the question is how much of oneself is the shrink obligated to mask in the name of being who their patients would like them to be? Outside the office, in ways that don't immediately impinge upon the lives of patients, I believe a psychiatrist is entitled to be whoever he or she is.

So, if my patients hunt my blog down, that's fine. I write with them over my shoulder, I'm aware the possibility exists, that the probability even is that some will find this. If a patient wants to tell me they've read Shrink Rap and use it a focus for a therapy session (or many sessions), that's fine. If a patient wants to read Shrink Rap and never mention it, that's fine too. If it's too much, too intimate, then I'd hope that patient would simply not read.


Anonymous said...

Kudos to you! Reading your post brought a genuine smile to my face. Who knew that cyberspace could actually have one of the senses....touch.
Thank you.

sophizo said...

Good for you Dinah! This is a great post on why you started blogging and why you decided to use your real name. I actually have two blogs that I regularly try and update. The one under this name is my anonymous version and I have a very public one where I am easily searchable. I'm very careful what I put on that blog because I know that every word is attached publicly to my name and picture. It's mainly meant to keep friends from around the country up-to-date on myself, but I am also aware that anyone (even from here) can find it and read it. I keep my anonymous blog because it is about things I don't want everyone who knows me to know about. People who don't know me are another story. And also for the fact that I don't want someone to google my name and find out who I'm related to (half of them are literally insane and very well known in their fields).

In terms of how your patients might feel, I know I'd be a proud. I'm one of those who would be the opposite of distressed. It would allow me to see that you are indeed a real human being. I think it would bring about a stronger connection. I've tried the whole therapy thing (being forced as a child and voluntarily as an adult) and have not been able to connect to one person. I just can't seem to trust someone I know nothing about. I finally have someone I can trust, but that is mainly because I know so much about him and his family/personal life (I knew him before I started with him). Not everything, but enough for me to see that he is just like me. Maybe I'm just weird and an anomaly in the therapy world.

Keep up your blogging. I know most if not all your readers enjoy it.

DrivingMissMolly said...

I really enjoy and appreciate the three of you and your unique voices and experiences. I feel honored to peek into the windows of your minds.

I can relate to blogging trepidation. I deleted my first blog. I have kept my current blog for quite awhile now though sometimes I still think of deleting it.

When I was 14 I tried to keep a diary. I, not very wisely, chose to hide it under the mattress.

I came home one day from school to find my mother and sister openly reading and laughing at my diary.

I vowed never to write about such private things again. I was devastated. But, you always hear about how important and helpful "diaries" can be so I decided to try blogging.

My friend and coworker, M, is the only one that knows about my blog.
My family doesn't know. I do have the URL in my suicide note because I think it might be helpful for them to see how down I've been, but I've just about decided to delete it before I "do the deed" because I don't want them to possible be hurt by anything I've written (No, I am not suicidal now, just prepared!).

On my shrink: I asked him if he had a blog and he said no. He didn't ask me if I had one, however. I'm sure he's waaay too busy to read it anyway. I mentioned "The Last Psychiatrist's" blog to him, though.

He has pictures of his family on his desk and I can see them. I don't look at them because I feel that area of the office, where his desk is and everything on it, is private space. He is Jewish and he has A LOT of Judaica around. It doesn't bother me because I feel that if it is on display I can look at it and if I can look at it I can have an opinion of it.

I think it's charming. He has a velvet thing on the wall and I don't know what it is, but it is stuck up there with multi-color pushpins which I think is funny.

His windowsill is full of what I think are patient's gifts because they are such a mish-mash of objects. I bought a Tinkerbell to try to sneak up there :)

I have pointed at the wall and asked him what things are and he very willingly answers my questions. If it's out it's fair game!

I know a little about my Shrink because I have read some articles that he has published on the Internet. I don't know HIM however, just some of his interests. Anyone that is a teacher and enjoys it as much as it seems he does, is a noble person.

I would not read his blog unless it was anonymous and I figured out it was him. I wouldn't want him to know that I know, you know? ; )

Lately, I have wished that I had an address to send y'all some chocolate. I know I am harmless but respect the fact that YOU don't!

Anyway, I'm sending much love to you telepathically, all of you.

Carry on and TGIF!!!!!!!!!

jcat said...

Agree with what Sophizo and Lily say. I'd also be proud if you were my p-doc, and I knew you were part of this blog.

My p-doc is pretty open about a lot of stuff - I know his wife is also a doc, they have a really smart kid, and because I like animals, I know all about his. He has family pics in the office, and a whole lot of other strange things like model cars. There's lots I don't know, and wouldn't ask either, because I don't need to know.

I'm sure he doesn't have a blog, because I had to explain what one was and why someone would want one. I know he's read some of Shrink Rap, after I've talked about specific posts - mostly the weird ones!!

If he did blog, it would probably be a total work thing (and more on the really esoteric research bits) because that's what he loves. I'd be open about reading it - and asking him to explain it in easier words. And yeah, proud that it was my p-doc writing it.

Oh yeah, and if he was going to post about something I'd done or said - he's just as much entitled to take something out of the session as I am - and again, I'd mostly be a bit chuffed that he found anything about me at all interesting. Just as long as he made me tall, skinny and blonde. And ten years younger...!

jcat said...

P.S. Have read your book, and enjoyed it very much. Not scary at all...

ClinkShrink said...

Sorry jcat..chuffed? Sounds like a great word but I'm clueless and willing to admit it. (Dinah would have asked if I hadn't.)

NeoNurseChic said...

Chuffed sort of means "pleased" but some can give a more exact definition... I've sort of picked up on saying it from Helen - she uses "chuffed to bits" a lot...which makes me laugh. She said I was talking like a life-long Brit by the time I left England - and I said it's because I tend to pick up accents really quickly and I like how they talk! lol....

JCat - what do you mean he's as entitled as you are to take things out of the session? Docs are bound by privacy....he can't just write about you on the internet - at least not in a way you'd recognize....or at least that's how it is in America. If people knew their shrink could talk about what they said in the session publicly, and not in a way that is medically necessary, they'd probably say a lot less!! But that's just me....

Take care,
Carrie :)

NeoNurseChic said...
This comment has been removed by the author.
NeoNurseChic said...

Here's a question... I'm curious what other readers (and the authors!) have to say about this... Do you think that psychiatrists would be more reserved about their personal life than psychologists or other therapists, like social workers, chaplains, school counselors, etc? If so, why?

I know my guidance counselor in high school used to actually share quite a lot about his life. He wasn't doing "therapy" - he was helping me survive high school by listening and giving me a lot of advice. When his mother came to live with him after his dad died, I actually would go over to take her to the store and just sit and talk with her so she wasn't so lonely. My guidance counselor and I even had the same birthday, so we would send each other cards.

Maybe it has to do specifically with therapy. Over the course of my life, l have turned to a lot of people for help with depression. When in high school, I had a few different places I went to discuss things - a student assistance counselor (a teacher), a stress support group at school (dumb, nobody ever came regularly), a favorite english teacher of mine who was also an SAS counselor but not my counselor, my high school choir director, my guidance counselor, one of the principal's secretaries, and a psychologist. Out of those, my choir director, guidance counselor, and the secretary were all very personal with me and shared things about their own lives. And to an extent, so did my English teacher. The only ones who didn't really were the SAS counselor and I think my psychologist. I know she shared more than my psychiatrist does, but I really can't remember a lot about what we talked about or our sessions - just a few of the bigger ones. I remember her talking about church at one point. And I think she had a daughter. That right there is more than I know about my current psychiatrist. Although, my current psychiatrist has implied that he thinks religion is a crutch - but I don't know if I just took that from a comment he made some time ago or if he truly doesn't believe in God. He wasn't making the comment to put down what I said - I think it was more to support something I said really....the times I have talked about my faith, he has not ever said anything to me about it not being real or anything like that...

I just wonder about this stuff!

Take care,
Carrie :)

Anonymous said...

Self-disclosure in therapy is an interesting topic. I've talked about this issue when I shared my experience of having an unethical psychiatrist with classes of therapists-in-training. One of the things that I've come to believe is that everyone, therapist and patient, know where that line is. The problem is, sometimes patients don't trust that gut feeling of this doesn't feel right to me. Because the belief is that he or she is the professional and therefore must be right, and I'm the one that's messed up. If what the therapist/psychiatrist is sharing feels wrong to you, then trust that feeling. I don't think that self-disclosure by a therapist is always wrong, but it most certainly can be. I think if they're sharing anything about their sex life, then that's always inappropriate. I also would caution against a therapist sharing their own stories of abuse. I think that can become a burden for the patient, and the hour shouldn't be spent on the problems of the therapist even if it's meant to be helpful. But, sharing about your children or family as long it doesn't take up too much of the patient's time can be helpful because it makes the patient see you as a real person. I agree with Sophizo that I'm much more likely to confide in someone who is warm and open, than someone who is cold and clinical. But there's a line that doesn't need to be crossed. If it starts to become more of a friendship, then there's a problem. I've told therapists-in-training that if you wouldn't be comfortable saying something in front of your spouse or your supervisor or hearing it repeated back in front of a group of your peers, then you probably shouldn't say it.

Anonymous said...

Dinah, great topic.

I've always had a very strange relationship with my pdoc... because in "a former life" or at least early in my life, I knew him in a different way - he is the family member of a good friend... and then after many years I was referred to him. Since he and his family sometimes vacation in the same place I do, I see he and his wife. It's very strange... In this case, I'd say the world is too small.

But in general, would I read his blog - I'd try not to. Because I'm trying to get to a point where I'm not obsessively thinking about him all the time. mayeb it's the fact that I never had a real relationship with my own father that causes me to think about my pdoc in a very paternalistic light.

It's my issue, so as a result, I try and keep everything as seperate as possible - but like I said, the world that I live in and work in is small... and everythign that goes around tends to come back around.

NeoNurseChic said...

Anon - Good advice, and I think that last bit there is excellent. Same goes with almost any interaction with patients in all settings. I'm a neonatal nurse, and while I have disclosed personal things with some patients, I am very careful about doing so and with whom.

I just wanted to add - in case what I said above isn't clear enough - my psychiatrist isn't cold and clinical at all. It's kinda a contradiction - he comes across as warm and open, but he does not ever say a thing about his life outside of the office, and doesn't have any pictures or anything in the office. He has always said I am more than welcome to ask questions about him, and that the burden should be on him as to whether or not he will answer - not on me for knowing what I should or should not ask. But I have a strong sense of boundaries....and when someone doesn't clearly put their own out there, I put them out there for them - at least when it comes to my interaction with them. Perhaps it's more self-protective than anything.

One further thing that I forgot to say is that when I pass my psychiatrist on the street, which has happened a few times, he doesn't say hi. Usually he smiles, but he doesn't look at me. Once I did say hi to him and he smiled in return with eye contact, but the majority of times, we walk past each other, eyes averted, not saying anything. This used to happen a lot more often because we worked at the same university, but now it doesn't happen as often. For those who are psychiatrists, what do you do? Do you say hi to your patients if you walk past them on the street? For those who are patients - do you say hi to your psychiatrist if you see them outside the office somewhere? If so, do they say hi to you? Do you not want them to say hi to you, so you don't say anything either? Does it bother you if they do or do not say hi?

I'm just curious!! The only reason I don't usually say hi is because I know he doesn't really - and it feels weird. But I have no problem with him saying hi to me - it's not like the people around me know he is a psychiatrist, and even if they did, I still wouldn't care. Anyone I'm close enough with to walk with them on the street somewhere probably knows I see a psychiatrist anyway. lol This part of the question is reminding me of Dinah's post about going to a patient's art showing - but I'm not talking about going to a patient's event really. Just like if you walk past them on the street or see them in the grocery store or something.

Take care...again!
Carrie :)

Catherine said...

As a teacher I can appreciate what you say about you being you. During my first years of teaching I was almost reluctant to go out for fear that I would actually *gasp* see one of my students. Now that a have a few more years under me, I am glad that both they (and their parents) see that I have a life outside of teaching. And let me say I am much happier that way.

Anonymous said...


A lot of psychiatrists (as far as I know - Dinah, Clink & Roy, correct me if I'm wrong) won't initiate contact with patients in public. It gets tricky when social conventions and norms would be to say hello to a patient (at least IMO).
Example: My shrink happened to be at an awards ceremony where a family member of his received an award. I also happened to receive an award at that same event. During the dessert break, he came up to me, put out his hand and said "Congratulations, great job", smiled warmly at me, and then walked away. Now, why wasn't that a problem? Because, in my mind, and probably in his, at least a dozen other people had come up to me and done the same thing. Was it uncomfortable? a little. Was it weird - no, particularly because he didn't mention it when I saw him for my session the next day.

So what i'm getting at - I guess it's worthwhile asking your shrink about it... Can't hurt.

NeoNurseChic said...

Rach - thanks for the response. I'm really just curious - but it doesn't bother me. And I don't really care enough about it to ask him about it really! I'm not interested in being friends with him outside the office - I guess I just think about a lot of things in terms of whys. I'm fine with him not saying hi to me - I just wonder what his motives might be. I'm fine with him not telling me anything about his life outside of the office (although I think knowing a few very basic things about him would actually probably help me feel less anxious and more at ease), but I do wonder why he doesn't say anything or have any pictures/personal things in his office.

I spend a lot of time just wondering why things are the way they are - not just about this but about everything. LOL I don't have any pressing need to change the way it is - it doesn't bother me - but I would love to know why it is the way it is.

Hope I'm making sense!

Carrie :)

Anonymous said...

I hope I didn't make it sound like a psychiatrist is cold and clinical if they're not sharing tidbits about their family. I don't have any hard fast rules about that. I think with self disclosure what matters is the purpose of the disclosure. For example, if a male psychiatrist shares with a female patient that he's divorced I would kind of wonder what the purpose of that disclosure is. Whereas, if a female psychiatrist or therapist shared it it might not mean anything to me. In fact, I can't remember how I learned that my female therapist (who treated me in the aftermath of the psychiatrist I had) was remarried, but it wasn't an issue at all. I never had that uncomfortable feeling with her. My former psychiatrist told me he was divorced (actually he was not divorced but that's another issue). It was just one of many things he said that left me with that uneasy feeling. He was king of the double entoundre which had me constantly questioning what he meant. I would give him the benefit of the doubt, so he would up it a notch the next time until it was really blatant like inviting me on a trip. But it didn't start out that way, he was testing the waters. That's why I say if it feels wrong (even if there's no concrete data) it probably is wrong. The only hard fast rule I have about self-disclosure is the one about a person's sexual history. I would contend that it is never, ever, ever appropriate to share info about one's sexual history with a patient.

My female therapist told she never initiates contact if she runs into a patient in public. She leaves it up to the patient. If the patients says, "Hi Dr. so and so," then she responds with a hello. But, she doesn't initiate it.

NeoNurseChic said...

I deleted my one big comment just because when I reread things I write sometimes, I decide that I don't want people knowing that much about me or what I think. Just wanted to explain why I took it down. A lot of times I get in a mindset where I have a ton of thoughts to get out, and so I write and write and write and write - but then when I reread them later, I just second guess what I've said. Just wanted to say why I took it down and why the other comments after it might seem a little out of context!

Carrie :)

jcat said...

Sorry...chuffed. British word for being pleased with something.

Carrie, what I meant by him being entitled to take things from the session.....obviously not that he go out and write something that says 'jcat was here and and and'. He and t-doc have open-ended permission to talk to each other. Apart from that, I doubt if he'd ever want to use anything about me - I'm really boring. But if he did, it would be ok with me. As long as he did it with a bit of 'softness'. Like calling me treatment-resistant rather than an ongoing loser.

Also, part of why he is so good is because he's had lots of patients before me and learned from their treatment. If he wanted to use that, and me, in articles or case studies etc, also ok.

I think in a way the whole p-doc blogging about patients, or talking about them, is cool if the patient is disguised enough so no-one other than they and the doc would recognise them. And that whatever opinion he gives is one he'd be willing to say to you in person.

Saying hello in the street? I would do it only if he wasn't with other people. I figure he has little enough time to spend with family and friends, and doesn't need it constantly interrupted by patients saying hello, so unless he saw me first and said hi, I'd avoid it.

A variation on this that makes me curious is my DuckBuddy. She and I met on an online thread about bipolar, met physically in hospital last year, both see p-doc. She has always been neurotic about him knowing that we are friends, so I have never said anything to him about her. She figures he'd be annoyed about it. I figure he couldn't care less about whether two of his patients are friends. She dumped me a month ago. And on Thurs, in the middle of the appt, he told me that 'my little friend is doing well, at last'. My jaw dropped....

Guess the Q is more for Dinah - are you comfortable knowing that your patients are friends with each other? And might be talking about you?

Dinah said...

Thank you to all those who said nice things!

jcat: Some of my patients refer their friends-- this is incredibly flattering, and I know they talk about me which is fine, I would just hope they don't say I'm fat. My fantasy is that they talk about what a great shrink I am, but who knows. In general, I don't care who my patients are friends with.

Re: running into shrinks in public and the complexities of say "Hi":
Psychiatrists don't mind saying hi to their patients outside the office and it's not an intrusion (though, please, Hi and polite small talk-- see Small Town Guest Blogger Mellow Dee's post for what Not to say. Probably best not to yell, Hey Doc I'm hearing voices again and I can't get it up!".
Here's the issue: if I run into a patient and I'm with someone, it's awkward for me in that my companion might say "Who was that?" and I'm at a loss-- I can't say "one of my patients" and I hate Ugh. If the patient is with someone, I don't want to put them in the position of being asked "Who is that?" and being forced to say "That was my shrink" if they don't want to, so I follow their lead. If the patient says HI, I say Hi (wouldn't anything else be Rude???). If we're both alone, I say Hi and chat for a moment.

So one day I'm out walking Max and I run into a patient, out jogging. There is no one around and we both say hi. "This is Max" I said. "I didn't know you had a dog," he said. At a loss, I just said, "I do and his name is Max." Patient said "Hi, Max." Max hasn't come up in therapy since then.

Honesty is hugely important in psychiatric care. I'm often a bit shocked when I read comments here about things people aren't telling their docs.

jcat said...

Thanks, Dinah, that was kind of the answer I'd hope for.

Guess part of it gets back to p-docs fall into a different category to other docs. My dentist and I now have about 5 different relationships apart from the one where I'm in the chair, and none of it is ever an issue.

If I bumped into p-doc when he was with people, and we did say hello, I'd have no problem with him saying to them that I was a patient. But then again, I'm way past the point where I care about whether people know I see a psychiatrist. Maybe for a lot of people that is something they'd want to hide.