Monday, June 08, 2009

Shrink Rap and YOU!

This is our 1036th post.

I want to ask you a question: Has Shrink Rap changed your attitudes?

Why do I ask? Well, you know we've been here writing about psychiatry and ducks and chocolate and rock climbing and technology for a while (follow Roy on Twitter ....oh, and I've gotten very good on an iTouch game called Fireball). We're thinking about the book we're writing and thinking about ways to keep Shrink Rap and the assort Shrink Rap-related activities fresh. I'm thinking about why we do this and what impact it's had, if any. ClinkShrink likes educating people about her important work with inmates and about how psychiatry and legal matters intersect. Roy likes fiddling with technology and talking about medications and we all like the idea of decreasing stigma and making psychiatric issues more understandable and accessible. I like trying to put what happens in psychotherapy into words, and this is hard. It's really hard, and I don't know that I do so well at it. So how are we doing and how has this helped or hurt?

I think we've talked about it before, but Shrink Rap has changed my life. I love blogging. I like the writing. I like the discussions. I like thinking about things to blog about during my day. I like the interactions I have with readers and the friendship I have with Clink & Roy. I like chatting with Fat Doctor on Facebook. I'm not so taken with Twitter, but I'm still kind of feeling it out. I like podcasting, mostly for the chili, but hummus is good and cake is great. If Oprah picks up our book, I'm going on a diet before we're on the show.

And Shrink Rap has been teaching me a lot, too. I've gotten insights into patient's thoughts and concerns that never come out in therapy. Many of them have been very encouraging, and sometimes they confirm what I already thought. Some of them have been jarring-- I've learned a lot about how angry people can be with psychiatrists and how trapped they sometimes feel: with therapists they don't like, with illnesses they feel their doctors should have been more powerfully able to heal. I've learned, too, that some patients/readers/commenters have very high, and even unrealistic, expectations of their psychiatrists. I love reading comments, but sometimes I'm surprised when I find myself feeling quite defensive, or thinking about something a reader said for a long time. Sometimes I wonder if we, as bloggers, have become a place for people to vent their anger towards their own psychiatrists. And sometimes I'm shocked to read about things people say happens with their own psychiatrists.

At some point, I imagine the three of us will want to talk about the role technology takes in psychiatry-- about education and stigma, and anything else that pops to mind for blogging/podcasting/twittering/book-writing shrinks. It might be helpful if we knew how we impacted you, in good ways and bad, and if you're getting anything out of this endeavor.
Might you click on "post a comment" and tell us?

Aside from that, I dreamt last night that I was sitting in on a psychotherapy session-- the therapist was Gina (Diane Weist) from HBO's In Treatment, and the patient was a psychiatrist I haven't spoken to in at least 10 years. Hmmmmm.....


Anonymous said...

Change of attitude?.... perhaps. More than anything, the blog/podcast/twitter has reminded me of the importance of maintaining peer relationships. One of the more enjoyable parts of residency was the dialog: book discussion, patient discussion... that is continued in some form in this forum. I find, as a private practice solo psychiatrist, that I crave community....which is found here online. So... Thanks!

JL said...

I just stumbled across this blog today (started seeing a psychiatrist for the first time ever about a week or two ago). Very strange. Not sure what to make of it. But I'm sure I'll enjoy browsing your page here. Guess I'll let you know if I like it.. If I get brave sometime, maybe I'll pose a question like: "If my new doctor (psych) reminds me of my father (seems condescending and I guess I don't feel in control in this relationship) should I just find a new shrink? Or should I just stick it out, on purpose, partly because he reminds me of my father?" (obviously he isn't my father. maybe this could be helpful.. I'm not really sure. I can't tell if this is a huge 'red flag' or an ideal opportunity to work through some of my issues.)
I'm sure I'll have fun perusing your blog here.

JL said...

I do have this important question, though - do all psychiatrists ask creepy freudian questions of their patients? This guy totally creeped me out! My husband said it sounded like a typical question (I was uncomfortable with it and surprised he had the gall to ask such a thing), but he did say I didn't have to answer.. But, it bothered me so much that I even had dreams about it a day or two later. Do all of you ask those kinds of questions? Is this just par for the course? Should I totally be looking for someone else to see? And part of me wants to answer that stupid creepy question. maybe I'm just crazy!
silly doctors.

Anonymous said...

Dear JL: My psychiatrist is over 65 and was originally trained as a Freudian and he does not ask creepy Freudian questions. He sounds like a human being and he does not make me uncomfortable about sexual issues or body parts if that's what you are talking about. I do not think a psychiatrist should be condescending. I would quit a condescending psychiatrist. Patients need positive messages not put downs. Also, you should have some control in the relationship. Those are all three red flags as far as I am concerned and I'd look for a different psychiatrist if I ran into that in the first few sessions. My psychiatrist is very respectful and he lifts me up, rather than tear me down. That is what you should be getting.

Regarding the blog: I must get something out of it since I keep coming back and others I do not return to. I think what I have seen is the psychiatrist's perspective. Even though I feel I am empathetic and can put myself in other people's shoes really well, I have gotten further insight into what it's like on the other side of the couch.

And yes, you are undoubtedly right about your taking the heat for the anger patients feel towards current or former psychiatrists (especially when you sound a bit like one of them) even if you are not guilty of the same offense.

Anonymous said...

For those in therapy you provide some insight into how it feels to be the therapist. Insight into why certain things occur, a reminder that you're just human as well, and even guidance on etiquette and the therapists' perspective on such things. I find it grounding, interesting, and enjoyable reading.

JL said...

Thank you Anonymous ;-D I think that helps quite a bit. Everyone keeps telling me the same thing, so I believe I'll go with the crowd on this one. I just wonder who to see instead.. heh
oh well.
It's kind of annoying feeling stuck. I'm seeing this guy as a 'last resort' almost (I prefer alternative health treatments to some of the western stuff).. So since I'm seeing a psychiatrist as a 'last resort' I automatically feel trapped (into staying there) just to make myself look good. (my last resort has to be the right answer, right?). That kind of thinking.. which is pretty irrational. There's also the medication issue.. He started me on something, and I'm obligated to return, I guess, to follow up for that reason if nothing else. And I guess I don't really have to do that. And then there's the therapist I'm currently seeing. And she says the psychiatrist I'm seeing is really good. (and I don't want to disappoint her or look like I'm running away from the help I need).
Thanks for your input. That helps.

itsjustme said...
This comment has been removed by the author.
Unknown said...

I love this blog! I found it through an interest in medical blogging (I'm in the process of applying to med school), and it's also been incredibly valuable to me as I go through the therapy - I like having insight into how the process works and what it looks like from the clinicians' side of things.

Christine said...

My interest in this site is multifaceted. Although I am a psych patient (bipolar II), that is secondary to the fact that I am currently in PA school and considering either family practice or psychiatry as my field of choice upon graduation next year.

I follow a lot of medical blogs from people in a variety of specialties. Some I enjoy more than others, but I learn or obtain something from each. I like to know what is going on in the field - within medicine in general, and within the specialties in which I am interested. As I see it, it is a way of keeping myself educated on current affairs within medicine on an up-to-the-minute basis.

I like seeing what the authors here think about current news and events, and the rationale behind treatment guidelines and common practice. I also enjoy poignant and well-written [confabulated] patient vignettes.

Overall, I like the blog, but I am a little disappointed to see so little contribution from Roy and ClinkShrink as of late. Likewise, I have started listening to the podcasts - I'm about halfway through them, but it seems that none have been produced in about a year. Are any more forthcoming?

Thanks for what you do. :)

Some bloggers are very condescending and derogative about the stupidities of lay people, and I really respect that you have avoided that type of negativity.

@coachkiki said...

Hi Dinah,Roy and Clinkshrink (who I'd love to read more from!)
It's me, @coachkiki, I first heard about you guys through @shrinkraproy and enjoy many of your blogposts. I love the idea of lessening the stigma of mental health needs. I've been trained "in the biz" but choose to work in an interdisciplinary way.
I love technology and am intrigued, albeit wary, of the way it can be used in service of your mission (and mine) - think "med school student syndrome" or "internet diagnosis syndrome".

I hear you on the responses and your reactions to them. There are lots of powerful feelings attached to the subject -I'll call it tech-transference, but that goes on even within the different schools of thought, treatment methods etc. within the field.

As for your dream - love it. Would love to hear more about it. Would you like to step over to the couch perhaps? Or a nice comfy chair?

Great work - thanks for keeping us informed on all the latest tech, tv and clinkshrink info.

Anonymous said...

I really, really, really miss the podcasts.
I wish you guys would do them again.

Anonymous said...

I really enjoy this blog! I work in the mental health profession, but also see a psychiatrist and therapist. I find it interesting to hear what docs are thinking and also patients. I wish you all blogged more often!

Randall Sexton said...

I don't have an attitude :)

Sue in N. Va said...

The three of you have a unique blend of personalities and specialties that works incredibly well together. It shows up best in your podcasts.

As long as you are enjoying blogging the other technological interaction, you won't be wanting for an audience!

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perishedcore said...

Do any of you practice in an acute care hospital inpatient setting?

If so or simply if interested, would you care to explore the issue of there being no standards of care or practice in either nursing or medicine for patients admitted to non-behavioral health units who also have diagnosed mental illness?

Second request for consideration of a so far unexplored issue: what supports, therapy and self-help strategies should be available to whistleblowers based on the reported work of C Fred Alford?

His book and summary article, Whistleblower Narratives: the experience of choiceless choice, provide a stark look at the experiences and fate of the non-headline making whistleblower.

As one myself who is admittedly sinking, I'd be very interested in your take.

As an occasional reader, I've enjoyed your frankness, humor, insights about patients, practices and the mechanics of therapy to be inviting and helpful, and always sensitive and entertaining. Many thanks!

Unknown said...

One of my favorite parts of shrink rap are your (all 3) descriptions of work. How you work, what your practices are like, how you set up various aspects of the practice, how you deal with various clinical situations.

ELN said...

All you're trying to do is change attitudes?

I suppose I have come to a better understanding of the varied species of shrink...such as the Collared Ozprey, the Red-Crowned Honeycreeper Warbler, and the Trop-iCal Scripter Owl.*

*I disclaim all responsibility for things typed while on zolpidem.

I could go on about how showing yourselves individually might counter stereotypes and work to change the attitudes of those who find all psychiatrists guilty of psychiatry's storied past, but I won't.

As far as I'm concerned, usually it's just an enjoyable stop in my favorite science blogs.

*I totally know better than to comment in this state...the stuff kills my better judgment. Should take more caution. Oops, nevermind, it's windy in here. Guess I'm going for it!

Aqua said...

Shrink Rap has become a very important part of my life; the posts are interesting, entertaining, and often extraordinarily helpful. Along with the posts,tThrough comments written on your posts I have discovered many other interesting and helpful blogs.

Your post often stimulate ideas in my mind, help me see myself and others more clearly and reinforce the importance of a therapeutic relationship with my own psychiatrist. They also encourage me to keep up with my logposts, because I too love to write and post and it is good for my MH to do so.

I do not always agree with what is posted here, but I always find your blog fascinating.

I am so glad all three of you have decided to share your knowledge, thoughts, ideas and experiences. You have really helped me in so many ways. Keep writing and I will keep reading.

Anonymous said...

This blog instructs me very much. I work as a psychiatrist in Japan, of which mental health culture has something differnt from that of USA.
For example there are still many japanese psychiatrists who don't hesitate to prescribe
huge dose of benzodiazepines to clients with minor problems.
I persuaded some of them to prescribe quetiapine instead of BZP, partly influenced by your articles about quetiapine.
Not so official stories about psychiatry like yours are really precious!