Wednesday, July 01, 2009

When the Shrink Needs a Shrink.

Somehow I missed this one, and Meg was kind enough to send it along.

Last week's New York Times had a piece by Elissa Ely on psychiatrists who need someone to talk to. I started reading it and immediately thought, oh, this is why we have friends, why we get together for lunch, why I have Camel and Roy and ClinkShrink! But as I read on, I realized that the issue raised was more than about having friends. It's about how awkward it gets as a psychiatrist ages, when s/he knows all the players in town, when s/he needs someone outside his circle to talk to about the more personal things. Therapy, after all, is not simply a substitute for friendship. Dr. Ely asks:

But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?

She goes on to write:

Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation — the nakedness necessary in therapy — is hard when you have been a model to others.

“In my situation, it would be difficult to find someone,” Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren’t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.

Surrendering that professional identity to become a patient reverses a kind of natural order. “You can’t be a simple patient,” Dr. Buie said. “Anyone I’d go to, I’ve known.” To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).

Dr. Ely goes on to talk about how some psychiatrists may have a preference for therapists who are older and wiser, that there is comfort to seeing someone who's been there before and who may have gained insights. Is this true for everyone? When I started at this, nearly all my patients were older than I am, and still, many people I see have children my age. They aren't psychiatrists, though.

I liked the piece. I've just started on the psychotherapy section for our book, and I'm struggling.
I've been working on the concept that some people seek care for insight and education (as opposed to for treatment of symptoms) and it's not easy forming my ideas.


Pissed said...

You know, I'm completely with you on this.

I went through a period last year where I was desperate for just a blank wall to bounce LIFE off of. I had a friend who is a psychiatrist and she went through telling me this person is good this one sucks so on and so forth, until I realized I didn't want someone she knew. So, I called some numbers, left some messages, and went to whoever called me back first with the nicest telephone manner.

I couldn't have asked for better. I was able to work through a lot of issues that were surfacing in my own practice with my patients and able to more effectively make myself objective since I was aware of those issues.


Roia said...

It is a dilemma faced by many in this line of work, or so it seems. I found myself nodding in appreciation as I read your blog post.

I'm a music therapist, and, although it isn't required as part of our training, I have felt strongly that experience in my own therapy is important and useful. I would very much have liked to have gone to a music therapist, but there aren't a lot who work with "normal neurotics", and the ones who do are far away.

Nowadays, the issue (as pointed out in the article you referenced) is that, after 21 years in the field (and having been active in my state professional organization), I am older than most of my colleagues, have more experience, and I know most of them personally, so it would be, well, sort of awkward.

Thanks for bringing up this rather pertinent issue. Good luck with the book section you're working on, by the way.

Rach said...

Dinah - you talk about trying to find thoughts about seeking insight and education through therapy...

I have a couple thoughts, feel free to accept/reject as you wish...

1) I think Life Coaching is a lot of what psychiatrists do, particularly for the "worried well", or those with long term chronic mental illnesses... It's pointing out patterns based on data and experiences shared, and using those patterns as the basis of understanding why people do things and how they can make their lives better by making change... I would suggest that successful psychiatrists (that is, psychiatrists who have patients that have positive outcomes) are able to incorporate such philosophies into their dialogues.

Liberal Jarhead said...

I'm a master's level psychotherapist rather than a psychiatrist or psychologist, and I've been seeing a therapist of my own off and on since I got into the field back in 1987. I think it's been one of the things that helped me avoid burnout or realize when my work environment was getting toxic, and I know there have been times when I needed that help to see some aspect of my own shadow that was slipping into various parts of my life including my relationships with clients.

When I went to grad school the program required each student to be participating in his or her own therapy before we could enroll, and about a third of the way through the curriculum we had to have done a set number of hours of personal therapy before being allowed to register for more classes. The psychologist who directed the program explained that it was important to stay balanced ourselves and to work through any raw spots we had before we started working with clients; she also knew that it would (or should) make us more empathic to our future clients if we'd been in their shoes.

It's inevitable that we'll hit rough spells and crises, and I believe it makes no more sense to try to get through them without getting our own therapy than it would for an orthopedic doctor to try to do his own knee surgery.

So I'm all for it, and it doesn't bother me to go see someone I already know. Maybe it's because I've been invested for a long time in both the professional mental health world and the 12-Step world where it's normal to dump your guts to your peers (as they say, the reason it works is that we're never all crazy on the same day.)

Anonymous said...

Cheryl Fuller also commented on this piece: