Missed Opportunities?

Before I begin,  I wanted to let you know that ClinkShrink wrote a post called Can You Tame Wild Women? over on our Shrink Rap News blog this week. 
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When we talk about psychotherapy, one aspect of what we look at is the process of what occurs in the therapeutic relationship.  This is an important part of psychodynamic-based psychotherapy, meaning psychotherapy that is derived from the theories put forth by Freud.  Psychoanalysis (the purest form of psychodynamic psychotherapy) includes an emphasis on events that occurred during childhood, and a focus on understanding what goes on in the relationship between the therapist and the patient, including the transference and counter-transference. 


In some of our posts, our friend Jesse has commented about how it's important to understand what transpires in the mind of the patient when certain things are said and done.  Let me tell you that Jesse is a wonderful psychiatrist, he is warm and caring and attentive and gentle, and he's had extensive training in the analytic method, he's on my list of who I go to when I need help, so while I want to discuss this concept, I don't want anyone, especially Jesse, to think I don't respect him.  With that disclaimer.....


On my tongue-in-cheek post on What to Get Your Psychiatrist for the Holidays, Jesse wrote: 

 When I say the Shrink should look at the context, even in small matters a gift might come with a subtext: "I just told you some terrible things about me and I want to be sure you still like me." It can be a bribe. It can be a seduction. It can simply be a gift given out of gratitude. The important concept is that we think about everything. Unlike a physical examination done by an internist, everything that occurs might be some window into how we can help the patient, and we do not want to lose that opportunity.

So wait, the patient comes to me because he symptoms of a mental disorder, often depression or anxiety, or problems controlling his behavior, or he's overwhelmed with stress and isn't coping well. Why is it so important that we understand every aspect of the sub-texted interactions?  How does this cure mental illness?  Why is it bad to accept (or not) a gift and move on?  Why do we have to think about everything?  And if it's really important, won't it come up again?  Is it really crucial that we not lose that opportunity?  Maybe I just want to take the cookies and say 'thank you' because

•   A) I don't want to hurt my patient's feelings,
•   B) it can be difficult to look at the meaning without upsetting the patient or putting the patient on the defensive and so the patient has to be fully on-board for this type of therapy and those patients generally don't bring gifts (ah, maybe we should be asking all analytic patients why they didn't bring gifts, now that might yield interesting information), and 
•   C) I like cookies.

So the truth is that on these posts, the comments are always the most interesting part, so do write in and let me know what you think, not specifically about the cookie/holiday gift example, but about how important it is to understand the interactions that occur within the context of the psychotherapeutic relationship.  


Just so everyone knows that I am still Jesse's friend, I am posting the video he sent me of his late grand-chinchilla, Chinstrap.  And yes, Jesse had a grand-chinchilla.  He does assure me that Chinstrap was having a good time in this video, because I wondered. 




And I'd like to thank Steve over at Thought Broadcast for providing the graphic for today's post. 

i before e, except after w?

I mean we're shrinks, we deal with the weird everyday. If anyone knows weird, it's us.

So I get this email from Roy. Stop spelling it "wierd" it's "weird" you have it stuck in your head wrong. He's right and he gave me a long list of places on Shrink Rap where weird is misspelled as 'wierd.' Only they weren't all me. Clink did it a couple of times. Sarebear did it in our comment section. I did it a bunch. This is weird. But it is "i before e except after c"...right? Why is weird spelled weirdly?

Maybe I need a new word. Strange. Unusual. Unconventional. Odd. That's a good one, even I can't spell "odd" wrong.

From Wikipedia:

Old English wyrd is a verbal noun formed from the verb weorþan, meaning "to come to pass, to become". The term developed into the modern English adjective weird. Adjectival use develops in the 15th centrury, in the sense "having the power to control fate", originally in the name of the Weird Sisters, i.e. the classical Fates, in the Elizabethan period detached from their classical background as fays, and most notably appearing as the Three Witches in Shakespeare's Macbeth. From the 14th century, to weird was also used as a verb in Scots, in the sense of "to preordain by decree of fate".

The modern spelling weird first appears in Scottish and Northern English dialects in the 16th century and is taken up in standard literary English from the 17th century. The regular modern English form would have been wird, from Early Modern English werd. The substitution of werd by weird in the northern dialects is "difficult to account for".^[1]

The now most common meaning of weird, "odd, strange", is first attested in 1815, originally with a connotation of the supernatural or portentuous (especially in the collocation weird and wonderful), but by the early 20th century increasingly applied to everyday situations.^[2]

Enough. It's all too weerd. The chinchilla is for Jesse because his preoccupation with the little rodents is kind of ....different.

The Sunday Morning Shrink Rapper Update.

I've decided to start reading the Sunday New York Times in bed--- no electronic distractions and I actually sort of read. I love the internet, but I think it makes me crazy.

The NY Times has a feature on Debra Winger and talks about her acting come back in the role of Frances on In Treatment. Click here if you'd like to read it.

I'm reading a wonderful book, a memoir by Dr. Mark Vonnegut called Just Like Someone With Mental Illness Only More So. When I was a kid, I loved Kurt Vonnegut's novels. Unusual family with lots of genius and mental illness. I will write more about the book when I finish it, maybe later today?

Tried a great new pizza place last night. Trouble parking and I thought I'd never go there again, and then we ordered a boring pizza because we have topping-issues in my marriage. Great spinach salad, and as we waited for the pie, I coveted the pizza's around us with sausage, veggies, mushrooms, oh.... but then our Four Cheese Pizza arrived and it was amazing. We didn't even mind that we were by far the oldest people in the place, and I will definitely go again, maybe on a weekday. So here's a plug for Iggy's.

As for the rest of my day? Roy wanted me to go to lunch with him so he could convert me into someone who fully understands the details of an issue that has come up in our state with hospital reimbursements. The restaurant he chose isn't open on Sundays. Oh, and he's decided he's busy with one of his many other projects. Clink wanted to work on posting another podcast with me, but got a last minute invite to a birthday party and has blown me off. I've pointed out to her that she was on my "A" list as a first-choice friend for a Sunday afternoon. The day-before birthday party invite and she was clearly on that person's "B" list. Apparently, my company doesn't compare to the prospect of birthday cake.

Our little dog, Kobe, the hyperactive one, was shaved down yesterday in an event called grooming. I suggested husband take him to the Ravens Game (Kobe would like that) but was told, "As a comfort dog? Kobe is the farthest thing from a comfort dog."

In Treatment: Jesse. Adele. Week 2.

Week 1: Sunil - Frances - Jesse - Adele

Week 2: Sunil - Frances - Jesse/Adele
Week 3: Sunil - Frances - Jesse - Adele

Week 4: Sunil - Frances - Jesse - Adele

Week 5: Sunil - Frances - Jesse - Adele

---

Jesse is obnoxious. Paul is obnoxious.
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Paul has his second therapy session with Adele. She sits stiffly and while she listens with interest, she isn't warm and fuzzy. Paul tells her that Max showed up on his doorstep. He talks about having Parkinson's Disease--- his fears of disability and decline and of passing it along to his children. The neurologist said he didn't have enough symptoms to meet criteria for Parkinson's, but that doesn't give Paul any relief-- he's going for a second opinion, as though he must hear that he has Parkinson's. He even talks about telling Max that he has the disease, the one he hasn't been diagnosed with, and he finally tells Adele about the dream. Oh, and Paul is reading Gina's book and he's angry: he feels that he was is the self-defeating character in the novel and Gina hasn't returned his phone calls.

Paul's session with Adele is not as contentious as the first session, but it's still tense and full of one-upmanship.

Is this what real-life therapy is like? Would anyone ever be a psychotherapist if therapy was anything like what is portrayed on In Treatment? Would anyone voluntarily subject themselves to this? No & no & no. These episodes are compelling, and certainly there are moments of confrontation in real life treatment, but Paul is morose, depressed, takes himself way too seriously, and all the sessions lack the interpersonal warmth that happens when someone confides in a therapist.
----

Speaking of Max: today is our older dog's 9th birthday (approximately). Bowls of liver all around!

Demystify Me!

We have a blog, we have a podcast, ShrinkRapRoy does some tech/med/psych twittering, and now we're writing a book. We've given one talk together, and once we're finished writing the book, we'll plan to do more as part of marketing the book (and the blog, and the to-be-resumed podcast) There's nothing to say we won't find more projects that compel us as time and technology move on. It's got me thinking that we need some umbrella organization to encompass all the different aspects of our work. I had a quickly-thought-of name; Clink says she can do better. Roy asked what our purpose would be and I assured him we'd have a mission statement, something to do with promoting dialogue, demytifying psychiatry, and decreasing stigma for mental illness. Roy added that we'd want to promote the destigmatization of both psychiatrists and the treatment of mental illness.

It got me thinking about what we do, and the issue of demystifying psychiatry. Do people want their psychiatrists/therapists demystified? Is there something about having that element...that distance, that assumption that the therapist is a little bit mysterious, unreachable, or somehow special in a way that regular people aren't, that is helpful (even if it's just not true)? Sometimes my patients ask questions about my life, or express surprise that I'd like, or do, something that isn't in keeping with the image they hold of me. What might be uncovered? Maybe that doc eagerly taking notes is actually writing a letter to his mistress (I hope not!) or behind the wise therapist fascade is an ordinary person stressing about bills, or a sick parent, or an ornery child, or their own irritable bowel. So demystify or leave it all alone?

On a totally different note: Roy got a New Puppy today. Oh my, is it precious. I went over to bond and the little guy (and he is little) curled up and slept on me.

Over at the Well blog....

You know I like all the Service Animal stuff the New York Times writes about. In fact, the Emotional Support Duck started off our duck obsession here at Shrink Rap.

From the NYTimes Well blog, Dogs and Autism:

A legal battle in New York City highlights the healing power of dogs for children with autism and Asperger’s syndrome.

Manhattan federal prosecutors have accused the owners of an Upper East Side residence of discriminating against 11-year-old Aaron S by preventing him from having a dog, The New York Daily News reports.
The report goes on to explain:

According to the newspaper, a lawsuit claims the building owners violated the Fair Housing Act by imposing unreasonable demands on Aaron’s parents before allowing a dog. Among the restrictions reportedly imposed by the building: the dog couldn’t be left alone for more than two hours, it would have to be taken in and out of the building on a service elevator, monitoring of dog walkers who might take it for a stroll, and $1 million in liability insurance for any injury or property damage caused by the dog. A company-hired doctor reportedly agreed the dog was medically necessary.

Oh, I'll let you all do the commenting.






NOTE from Clink: Now the duck works.

My Rather Weird Life

Just back from meeting with Jon, the idealistic fitness trainer who will save the inner city from the epidemic of obesity and save me from myself.  Every muscle aches.  And so I come upon a box at my front door.  I love presents.  Who doesn't?  Thinking it's a book I ordered, I note the address: 

Dinah, Chef de Haute

Dinah's Tex-Max Bistro

Hmmmm.  Seems unlikely I'd send myself a book to that particular address.  Maybe I was taken over by aliens?

Eagerly I rip open the box.  The contents: 2 boxes of King Arthur Flour (est'd 1790) Quick & Easy Homemade Dog Biscuit Mix from ONLY the finest flour.    Oh, and let's not forget the multi-sized cookie cutter's shaped like dog bones.

My day is complete.  Max's Day is even more complete.   Perhaps Fat Doctor's son (the notorious little boy dog biscuit eater) would like to come over for a snack?  Or Jon's foster dog Molly?  And wait until Tex sees what Max now has, jealously amongst the pooches will abound.

Thank You, Victor.  I'm not sure what else to say.

Sex With Fish, Revisited

Some fish are Journey fish. Some fish are Destination fish. Some fish taste good. Most fish don't have sex and I'm not sure what to say about the fishy version of inter-fish intimacy. Generally, people do not have sex with fish, but I suppose to each his own.

Why is Dinah rambling?

Okay, so every Monday, we get a report of our site visits, our referral sources, a map of the country with shades of green depicting how many readers from how many states: Thank you, California, where the most Shrink Rap readers hail from. We usually have readers from every state, though some weeks, no one visits from South Dakota or Montana or somewhere around there.

We know what people Google that gets them to us. 'Shrink Rap' is one thing. But week after week, for years now, every report lists "Sex with Fish" as one of the top five most Googled terms for a referral to Shrink Rap. Every week. I now look for it. I've Googled "sex with fish." I don't get it. Reef-fish change sex (although I think this might mean gender, so any Reef Fish visiting Shrink Rap should please check off "In Transition" on our Gender Poll on the side bar.

I just thought I'd welcome anyone who was here looking for Sex With Fish. You've found the right place.

My Wish List For 2008

Dinah is off to a warm sunny place this week, leaving Roy and I to care for the blog.

Uh oh.

Much as we (I) like to tease Dinah about talking too much, the fact of the matter is that it's nice to know she's here taking care of the blog when real life intrudes on my blogging capacity, which lately has been pretty often. So in her absence I thought I'd put together a list of things I would like for 2008:

I'd like a never-ending list of topics to blog about that really catch my interest.

I'd like Dinah to have good-hair days, every day, all year round.

I'd like Roy to keep getting the latest and coolest Mac gadgets so I can enjoy his geekhood vicariously.

I'd like Dinah to have her own iPod. Really, she deserves one.

I'd like to have an organized and coherent podcast. I really believe this can be done and that we should do it, or try to do it, at least once.

I'd like a list of good non-crunchy food to eat during our podcast tapings.

I'd like pet-sized mikes for Monkey and Max so they don't feel left out during our podcasts.

I'd like Blogger to start showing our little icon pictures again when we comment. I miss seeing my little guinea pig behind bars.

I wish my patients would behave every day, all day, for a full year. (Hey, I can dream can't I?)

I wish someone would give me an office. Or maybe just a telephone. (I did get the heat turned on a few weeks ago---I'm making progress.)

I wish someone would explain to me how "pregnant pigs" came to be one of our post labels.

I wish all our listeners and readers would continue to find My Three Shrinks a comfortable place to learn, ramble and rant. It certainly has been for me.

Finally, I wish the best of all good things to both of my co-bloggers. I've had a wonderful time with both of you.

Glow in the Dark Cats

Apparently, the South Koreans have cloned Glow-In-The-Dark Cats! Wow!
Max and I want one. My family has never owned a cat, but just think how cool it would be to be the first on the block to have one of these? Hopefully they'll be easier to get than that Nintendo Wii thing was.

Failed Heroism and the Shrink Rappers Pursue the Perfect Pizza

The Shrink Rappers have a new quest: to find the best pizza in Baltimore. Don't get me wrong, we still like ducks, but this is a culinary adventure.

So, Victor started it: he read about Matthew's Pizza in a Laura Lippman novel. Clinkshrink couldn't wait, she went without us. Roy says Carmine's is the best, and he's currently in Las Vegas trying to win the big bucks to pay for new recording equipment for our My Three Shrinks podcast. We started without him.

So it was a bit of an adventure getting to Matthew's. First there was the parking space issue, and then, as we walked the few blocks to the restaurant, we came across what appeared to be a dead body in front of a church. People sleep on sidewalks on church steps
all the time, this gentleman was in the middle of the sidewalk. Clink asked him if he was okay, and as he raised his head, there was a small pool of blood on the concrete. We called for an ambulance, and Clink asked the man a few questions, she had him move all his extremities, he seemed coherent, and Clink was relieved that he didn't seem to be one of her patient/inmates. He said he'd been jumped and someone tried to take his money. The blood was coming from a small laceration on his forehead and it seemed to have stopped bleeding. I called his wife.

"I'm looking for..." oops. Excuse me, sir, what's your name?
"I'm looking for John's wife (not his real name)."
"I'm his EX-WIFE." I told her we'd found him, that he seemed to be okay, that the paramedics were here wrapping his wound, that he'd been mugged and hit his head and was going to be taken to a hospital.
"He had too much to drink," she said. And judging by the smell of things, she may have been right.

My second attempt to be a hero this weekend happened when I was walking with Max. We were far from home on a quiet road when we met a wet, slightly bedraggled little dog standing in the middle of the street. I guess I think that when people or dogs actually belong somewhere, they move towards the curb. I would have assumed he lived there, but I looked at his tag and it gave an address that was miles away. Poor little thing. I tethered him onto Max's leash and walked around the block to a friend's house. Their kitchen door was open, so I walked in with two dogs in tow, and asked for a phone.

The tag identified the dog as Louis Vuitton Adams. This is his real name, I've decided that anyone who names their dog Loius Vuitton should expect to find their pet on someone's blog. That's the Adams' dog, I was told. Apparently his owners have divorced and the address on the tag is the ex-wife's address.

I thought I was rescuing a dog, instead I had stolen one.

So Matthew's Pizza was wonderful. When Roy comes back, we'll try Carmine's. If he's lost all his money, it's okay, ClinkShrink will treat. If you know of any great Pizza places you'd like to us to try, please write in. I'm up for a pizza project.

Oh, was this supposed to have something to do with psychiatry?

Feline Felons Released to Home Detention

Anybody who knows me will know I can't resist a story like this. It combines cats and prisoners, two of my favorite topics. (If you could figure out a way to work chocolate in there we could have a trifecta.) Here's the story from CBS news:

Vermont Prison Paroles Cats

Apparently the women in this particular prison took to caring for the various strays that took up residence there. It's not clear what actually precipitated the decision to find free society homes for these cats, but they've gradually been giving them away (after appropriate spaying or neutering).

When I first read this story it reminded my of my long-ago post Paws For Reflection where I blogged about my favorite drug detection dogs. (Can you believe our blog was only two weeks old back then?) These cats don't have any institutional responsibilities other than to be loved and adored by the prisoners. Rough life. Don't they know prisoners aren't supposed to be cuddled...er, coddled...even if they do have fur?

My other thought was: "Gee, don't they know that 'cruelty to animals' is one of the diagnostic criteria for antisocial personality disorder?" And indeed, one poor animal did get his fur burned off by an inmate. (What are the chances that inmate was given a written infraction for that?)

And so they are off to home detention. I'll give them the traditional prison send-off:

"Be safe out there."