Thursday, May 31, 2007

What Kind of Psychiatrist Are You?

First: More of chapter 7 is up on Double Billing. If you haven't visited lately, please do. Chapter One has been voted out and replaced, the story is moving along...

So I'm finishing up a session with a patient today and he suddenly asks, "What kind of psychiatrist are you?"

The question caught me off-guard as all sorts of things rushed through my head. Oh the usual kind of psychiatrist. The kind who writes a blog.

"What do you mean?" I asked. I wasn't sure what he was looking for.

"Like, oh you know, Freudian, that."

I rambled a bit inarticulately, still not sure what the question was. I told him where I did my residency-- if you're a local psychiatrist that means a lot and I could get plugged into a neat little stereotype. The patient is in car sales and doesn't know about ideological difference between the different programs in our fine city.

"I'm a general adult psychiatrist," I said. "I don't see kids." So there, something I'm not. I'm still left with wondering what I am. "I'm not a psychoanalyst, and I don't even know any Jungians."

Okay, I was babbling. It wasn't the first time. If you listen to our podcasts, you know that. Really, I was trying to guess at the question, what did the patient really want to know, what was the wish, the fear, the concern here? He'd only seen one other psychiatrist, and only for a few visits. I knew he didn't like her-- did he want reassurance that I was different? He knew that already, after the first appointment he'd commented about how different I was than Dr. EvilShrink. Figuring Dr. EvilShrink was his only frame of reference (and Woody Allan, of course), I babbled some more:

"Dr. EvilShrink sees patients for medications and sends them to see other professionals for therapy. I do both therapy and medication management."

Then I recalled how Patient was really not very interested in psychotherapy, or so he said. Talking was a chore and he just wanted to feel better. Not everyone has to talk, I take 'em as they come.

Patient made an appointment and left. I never did figure out what he was asking or what he wanted to know. Maybe he just wanted to hear me babble, so hopefully I obliged.

And Roy, you've inspired me to hit spellcheck. I just don't have proofreading in me. It's good I have you.


Rach said...

I totally don't understand the graphic on your post, Dinah.

And to be honest, when I was looking for a new shrink, I just wanted someone who listened... That's really good enough for me. Jungian, freudian, whatever.... All the same difference, isn't it?

Anonymous said...

I'm not sure I understand the graphic either. I figured he was the kind of psychiatrist who listened to people while they lie in a shoe talking. I'm not that kind of psychiatrist.

Some people want to be listened to, others want good drugs, some are searching for answers, some want their unconscious conflicts elucidated (we'll wait and see if Roy says I got the spelling right). I guess some want to be in shoes?

ClinkShrink said...

The graphic seems clear enough:

The patient wants solely supportive therapy.

ClinkShrink said...

Or maybe she just wants to be heeled.

NeoNurseChic said...

So, if you're not a psychoanalyst, and you're not a cognitive behavioral therapist, what does that make you? I know there are more categories than this, but I've been thinking about this recently, after finishing the book, "In Session" by Deborah Lott (recommended to me by Sara). I wouldn't say my psychiatrist is a psychoanalyst, but he is much more of a psychoanalyst than anything else, in terms of categories. We are free to talk about whatever - I do not know much about him at all - he does not tell me what to do, or what he thinks I should do - and the overall goal seems to be to help me live the life I want to be living and to make more informed choices. Also in those goals is working on personal relationships - analyzing the problems I have with them (as well as what I do right), and working on developing the personal relationships in my life - family, friends, romantic, etc. I have other goals, such as alleviating depression and anxiety (or learning to better manage it so that it is not managing me), living and dealing with chronic pain, and medically treating my ADD, but otherwise - we aren't terribly goal-directed in that goals do not shape every single thing we discuss. This makes me feel better because I once went to a therapist who kept pushing me for goals at each session, and I finally quit because I'd "conquer" some short-term goal and then feel like, "Well, that one's done, so I don't know what to work on next..." That particular therapist wasn't very good with long term goals. I've also been to a cognitive behavioral therapist in the past, and that was fine at the time, but I like what we do now much better. I like the freedom of talking about whatever I feel like talking about....even though he often pushes me to talk about things I don't really like to talk about, but for a good overall purpose. I feel he is very supportive, and I feel comfortable talking to him, even though, like I said, I do not know much about him at all, which sometimes makes me uneasy. He said the other day that not knowing much about him can work two ways: on the one hand, it means that I wont' take random information about him and form stereotypes based on that information; but on the other hand, it means that I will imagine up various things about him and form stereotypes about those things - just to fulfill my human nature to categorize and make the relationship more two-sided in some way.

OK - enough rambling!! I think it's a valid question that your patient asked there - but the answer can be complex....... I think saying your personal "mission statement" would probably be a good start, really!

Take care,
Carrie :)

Roy said...

Good ones, Clink. I thought this was Dinah's reference to Talkshoe and our using it to do Podcast #20.

Oh, no, I got it. Alright, this is good. Yo, Dinah, you misspelled Woody Allen's name. Well, the pic is related to Woody. That's Woody in the chair, but he's playing a Mexican psychiatrist talking to a woman in a "Sleeper".

Zoe Brain said...

Maybe the patient was just trying to get someone to see what it was like in her shoes.

A Rorshach cartoon?

Anyway, one topic for a good blogpost would be a Taxonomy of Shrinks. Most people (e.g. me) are fairly clueless about the differences between Pschychology, Psychotherapy, and Psychiatry.


Jung seems like Ju-Ju, Freud is abseud, Rogers is Dodgy, but without a thorough knowledge of neurophysiology, we're whistling in the dark.

Software Engineering, my bailiwick, is so godawful primitive I wonder how the hoi palloi ever tolerate our lack of knowledge. We do what we can, but the state of the art is woeful.

I suspect psychiatry is much the same - to take an analogy, we're using Axes (such as SSRI chemicals) instead of nanoscalpels, because we're barely out of the flint-tool stage.

Anyway, I'd be interested in what the Three Shrinks have to say about the taxonomy of their profession. Just idle curiousity on my part, I no longer need letters de cachet from Medics for any treatment. The only reason I'm seeing a psych now (once every 6 months) is for a 5-year follow-up. So many people drop off the screens after treatment, I just want to help get more data, but I digress.

Anyway, this involvement with the Mental Health profession that I've had in the last 18 months has stmulated my curiousity. I think it takes a very special set of qualities to be competent in the profession, psychic strength, immense intellect, empathy, courage, those are just some.

I know some in the profession lack many of these qualities too. Every field has its less-than-competents.

I wonder how you can deal with someone in terrible psychic pain, knowing they probably will deteriorate until their personality, their humanity is gone, and then go on to the next patient and try to do your best for them too. That must take some resilience, some indefatigability, and yet it must be damaging as well. You'd have to regenerate, and heal after each less than wonderful outcome.

No wonder you blog. Thanks. Remember the ones where you won, Ok?

Rach said...

Dinah,interesting comments on the good drugs. Yup, I think I've been there at one point (is Lithium a "good drug"? hmmm I think I have a blog post for my own blog now)... But yes, I think you've hit the real basis of therapy, that people come out wanting more than when they walked in to therapy for the first time. Ok, gonna run with this over to my world of lunacy. Feel free to drop on by.


Anonymous said...

Zoe Brain wrote: "I wonder how you can deal with someone in terrible psychic pain, knowing they probably will deteriorate until their personality, their humanity is gone, and then go on to the next patient and try to do your best for them too. That must take some resilience, some indefatigability, and yet it must be damaging as well. You'd have to regenerate, and heal after each less than wonderful outcome."

Zoe Brain: Oh my, I haven't seen anyone deteriorate out of their personality or humanity. People wander in in pain-- mostly they get better-- rarely do they remain persistantly tormented, and so I now detach-- I offer hope (someone's gotta be hopeful) and reassurance. Really, it's not so bad. Actually, it's pretty good.

Carrie-- you're psychiatrist sounds like a caring and competant man. If he's helping you, it doesn't really matter what he is.

Rach-- I'm always pleased to be inspirational for any writing endeavor. I couldn't, however, seem to access your world of lunacy, I'm not sure why, but please know I tried.

Rach said...

Dinah, here is my world of lunacy: --> blogger isn't allowing people to access it from my profile.. But there you go.

Gerbil said...

On the graphic:

"Doc, I'm an old woman. I live in a shoe. I have more children than I can count and I just don't know what to do anymore!"

Rach said...

ROFL Gerbil.

(My apologies to D,C and R) - Carrie: what did you think of "In Session" - I read it several months ago and I keep lingering on it...
Dinah, Clink and or Roy - have any of you read In Session - I'd love to hear your thoughts on the book, seeing that you sit in the other chair...

Anonymous said...

I think the image is how men see women - if they like your shoes, hen you are hot stuff.

DrivingMissMolly said...

I kind of thought that the shoe meant that was all the woman thought of (she's frivolous) or that was all that the shrink assumed she thought of (shrink's sexist)... or, it could mean that the woman is trapped within the role represented by the shoe...femininity?

Kind of a dismissive stereotype of a woman, even a woman seeing a shrink...But, we all know that shrinks are NEVER dismissive of their female patients....Haha

It's a funny coincidence that this post came out because I saw my doc a week ago and I wanted to ask him the same thing! I wanted to know his approach. I don't know....why are shrinks so damned mysterious anyway....

Sometimes I think I have "abandonment issues" mostly because the last couple of shrinks I've seen have said so, not because I actually have them.

He has also mentioned that he is concerned I could have a potential for addiction that NO ONE has ever told me before. I rarely drink and I have never done any illegal drugs.

I think he wants to make me into something I'm not because I need to fit his "template."

I need a cartoon to show the shrink confined by his loafer.

I wish he'd be more accessible.

This is weird, but I wish he'd wear a teddy bear suit and I could sit on his lap and he'd just hold me with his furry teddy bear arms.

Why are you guys so cold, distant and remote. I hate that.


Sarebear said...

Because, Roy, as far as good shrinks go, she's a shoe-in. Or in a shoe . . . .

Sarebear said...

Clink, great puns!

Roy and Zoe, ha ha!