Wednesday, May 14, 2008

It's My Life, I'll Blog If I Want To

So while we were giving our talks on On-Line Communities and blogs at APA last week, a gentleman asked a question about "transference." I took the mic, I figured it was a question for me since I have the psychotherapy practice (in addition to being a Community Psychiatrist in clinics that serve the chronically and persistently mentally ill----I'm starting to get touchy about this).

So I talked a little about Transference to The Blog and how some of our readers seem to have their own ideas about us and who we are.

No No No No No! The gentleman wasn't talking about transference to the blog, he was talking about how my the existence of the blog effects my real live patient's transference to me! A totally different question. This has been an issue since day one, at least as an issue that other psychiatrists always raise to me. So far, I've been left to say that I'm not aware that any of my patients have found Shrink Rap. I wrote, way back when, about The Blogging Shrink
mostly in response to commenters who felt uncomfortable with the whole idea of a psychiatrist who blogs, maybe about their patients in a confidentiality-violating way, or maybe about the discomfort of knowing too much about what goes on inside their shrink's mind or life.

Since no one patient has told me they've read our blog, I talked instead about the responses I've gotten when patients have read my novel: Monday at The Charm. The truth is, none of the patients who've read it have been completely comfortable with it. One was obviously uncomfortable, the book is graphic, it has sexual (paraphilic, actually) content and the characters are a bit free with the expression of profanity. Clink, of course, was inspirational.

Whenever people asking me about my writing and my patients' reactions, inside I get a little queasy. Outside, I get a little defensive. It's as though I feel, or I hear, that by having a life other than the quintessential silent shrink life, I'm doing something wrong. You're not supposed to be out there, a literal open book for your patients to read. The old psychoanalysts went to great lengths to remain 'blank slates.' No family pictures in their offices, some didn't wear wedding rings, there were rules about who would leave if the arrived at the same party.

So I'm a writer. I don't volunteer this, my novel isn't displayed in my waiting room. I don't hide or deny it either, and if I have something I want to say, sometimes I say it rather publicly. I don't know how it effects my patients, and I don't know what I can do about this anymore than I could control if a patient found out something about my personal life. "How do you feel about this," is the best I could come up with.

And I'm not leaving a fun party if a patient shows up, but I might drink a little less and skip the tabletop dancing.

Before I go, the same gentleman asked about the gender of our readers: so please do take the sidebar poll.


Anonymous said...


Interesting blog!
I must say it is a great question about transference.
Patients can get very curious about their doctors.
I had very difficult pregnancy and was admitted in the hospital for 7 weeks.I did get very curious about my doctors and read almost all articles published by my Perinatologists through the university website!
Google and pubmed make it very easy to kinda know someone if you want to!
So do not worry its not just blogging, if some one is curious they will know you whether you blog or not!!

I am new to psychiatry blog. I would really appreciate if you could read the following post.
I wrote it almost 6 months back.I am totally fine now.It was just a case pf post partum depression but I kinda used the sublimation technique and wrote not so rhymy poems instead.
Check it out!


ClinkShrink said...

It is interesting that none of us (as far as I know) have had patient reactions about the blog or even any indications that they know the blog exists. I guess it makes sense in my case since my patients don't have Internet access.

I'm glad I could be inspirational for the book. (And before anybody asks, I wasn't the inspiration for the paraphilia or profanity. At least as far as I know!) :)

Midwife with a Knife said...

Hm... you're not a nun (I suppose that's clink!) ;) And patients have choices. If they find the blog and it makes them uncomfortable, they can talk to you about it. If they're still uncomfortable, they can find a different doc. Same with the book.

I think it's fairly obvious to people what kind of a person and obstetrician I am (for better or for worse) from my blog. If they see it and decide I'm a looser, they can find a different obstetrician. I won't even blog about them. ;)

Anonymous said...

Your blog would not bother me if you were my shrink; I'd be proud! Shrink Rap is a wonderful accomplishment.

Won't it be a bit harder to hide once it's a book? That would especially true if you are on "Oprah" talking about it. :-)

My shrink has aked me several times if I mind if he shares my stories with friends of his. I tell him to go right ahead because it does not bother me. It doesn't bother me. At all.

It WOULD bother me I suppose if he had blogged my stories and in his writing disclosed interpretations that he had not shared with me or if he wrote what I would interpret to be critical.

Rach said...

wow therapy patient... I'm a little bit stunned by your shrink. I mean, I'm glad he asked you if he could share your stories (I guess they're interesting/funny/scary/shocking), but I feel like that office is my inner sanctuary - almost like the inside of my skull, and I'm merely purging my thoughts to someone who is trained to interpret them and help me make sense of the craziness inside my brain.

I think I'd be put off, almost offended if my shrink asked me that. And anyways, I really don't think I'm that interesting to start with.

Awake and Dreaming said...

I have always assumed that my therapist talked about me to people. I mean, besides the fact that she was a student and had to write about me and analysis me and all that for her teachers and supervision group. Our sessions were video taped, we even did live ones in front of her whole group.

I guess, yeah, I always figured she talked about in a sort of confidential way. I know I talk to my best friend about my clients in a rather vague way (and sometimes perhaps in not as vague a way as I should) but that's cause she's another social worker, and I bounce ideas off her. I supose truly, it never occurred to me that stuff wouldn't be talked about outside the therapy room, I just figured my name/picture/identifying details wouldn't be attached to it.

As for my blog, I'm not sure how I'd feel if my clients found it... that's why it's anonymous. The fact that many of my clients are illiterate and have no internet access also decreases the likelihood of them finding it. That being said, I try to blog in a way that would be okay for them to read, except really, it wouldn't be. I also wouldn't want the staff at work to come across it either. Actually, i think the issue would come in the clients reading my comments about the other staff, not my comments about them. The stories are very confabulated so it would be hard for them to pick out something and say "hey, that's me"... cause it probably isn't, or at least, it's not totally them.

I think, if I had come across my therapist's blog, I wouldn't have read it. That's just who I am though.

p.s. i ordered your book used off amazon. I'm curious, and my public library doesn't have it.

Anonymous said...

I would bet some bucks that at least a few patients of the blogger who does not use a pseudonym, have seen the blog, read the blog. The same way that some people know some personal info through other channels about their shrink but would never ever bring it up because they do not want the shrink to know they know and in the end as far the therapy goes, if you aren't talking about the patients in your blog and you aren't posting things that sound really unlike the way you tend to sound generally I doubt anyone is going to get upset by it. They might go home one night thinking yeah, I thought Dr so and so seemed a little distant these days but oh ,what's that I read here, she is worried about her kid, okay whatever. Or, Dr so and so, said she was going to have to cancel for this week. Oh, she is going to the APA or Oh so that is the kind of dining room furniture she has, not my taste,but again, whatever.
Plenty can come from the blog that is good and not so good so long as you can take either then, go for it.

Jen said...

Interesting post. I certainly know a lot of personal things about our specialists and family doctors for various reasons (social friends, small community, our very visible family, and sharing a semi-private room with a doctor's family at one point), and that's never affected the way that I see them- if anything, it's helped our clinical relationships. I don't know about anyone else, but I find it reassuring rather than not to discover the "human" side of professionals.

One of our autism doctors wrote a book a few years ago, and with our permission, wrote a chapter on our family using pseudonyms for us about the first year that all of our kids were diagnosed. I found it fascinating and insightful (and ultimately helpful), to see the different way that he perceived our interactions with him and his office as opposed to what I remembered and what other people who were with us that first year of diagnosis remembered, and it was an insight that I never would have received without reading his writing.

The same goes for my therapist- I wouldn't have a problem reading his blog, because if anything, it would make him seem more human (and he's already a pretty amazing guy). I think that for a lot of patients it might be helpful to realize that they're not the centre of their therapist's universe, and I figure that if he knows everything about me and we're dealing with each other as humans, then I can't see it being a problem reading what he writes. (Of course, that pre-supposes that he's not going to be calling me the annoying psychotic mom).

Anonymous said...

Still Dreaming,
I hope you enjoy it! Thanks for reading.

Anonymous said...

re sidebar poll: are you talking equipment or are you talking identity and would that be how others would say they view you or how you view yourself? i don't think i actually have gender but my driver's license says otherwise. i don't think that the gender thing is so tied in necessarily to what whether you go for a prostate or a pap test. really hard to answer. i think there are really more than 3 possibilities but i do concede that mostly people will fall into one of the first two.

green tea said...

I would have a really hard time if my therapist had a blog. It would make them seem too "human" too fallible. I think part of the illusion of therapy is that the person sitting across from us brings their BEST person into the room. In the blog, it's hard to maintain that sense of bounded distance. That detachment that invites a client inward, and into themselves.

As an aside-- why use the word "transference" when "relationship" is more apt?


Anonymous said...

I'd think it was cool if my shrink had a blog like this:).