Psychotherapy

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In 1932, my paternal Grandmother-Of-Blessed-Memory bought the house where my father and aunt – and eventually my brother and I — grew up.  Until her passing while I was in medical school, she was the undisputed queen of the castle.

As a stereo-typical Jewish Mother, she was in constant competition with my mother in the kitchen.  My mother always tried to act pleasantly, but between her father driving in from two hours to the west and arriving at 6 am on Sundays to tell her she was too fat, and my father’s mother besting her in the kitchen, she was generally miserable and had little ability to hide her misery from me.

My father did not show my mother any affection where I could see. Read more on The Power Of Silence…

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California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”

The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”

That should be encouraging for people like my 27 year old, freckled, red-headed patient.   After all, he had a pool cleaning business. But he was nervous — really nervous.

He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.

He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.

This guy was anxious. Read more on Stuck On The Treatment Treadmill…

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During residency training in psychiatry, when I was learning how to do psychotherapy, I learned that the lady at the front desk ran the clinic.  She did the “statistics.”

I thought she was hyper, but she told me she subsisted on coffee and crashed on the weekends.  She actually told me so much personal information, I suggested she become a patient at the resident clinic.  She said there was a rule against it.  I told her to go to another clinic, but she told me she could not get time off, something I never quite believed.  But she told me, also, that she understood what was going on with me.  This was news to me, except that I knew I was struggling to be a good psychotherapist.

The stories of everybody’s lives that they told me were so terrible I thought I might just go home and cry every night.  I did a little at first, but I got over it.  Then, she told me my “statistics.” It seemed that more of my patients came back for more visits than anyone else’s.  They liked me. Read more on You Don’t Have To Be A Jewish Mother To Have Empathy…

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It was not the first time I had spoken with this attractive, fifty-ish woman.  The first time this co-worker had come into my office at the clinic where we both worked “to say hello.”  She occasionally stopped by to report to me one of her great successes with a patient.  Often she would also tell me how wonderful I was.  But this time, her pleasant visit ended with a real break-down, reducing this lady to teary exclamations about how horrible her job was.  The tears and complaints spilled out so fast that she soon was complaining about how rotten her entire life was.

burnoutI knew this person was a cracker-jack therapist — one of the best I had known, ever.  Until then, I didn’t know she was also miserable, with the worst and loneliest professional life I had heard of in a while — divorce and abandonment from men who sounded as if they had not been as resourceful and energetic and smart as she was.

It was a clear – and severe – case of professional burnout.  Of course, that’s not a real psychiatric diagnosis. She may have needed something for depression or anxiety or both, but there was no way — none at all — I would ever consider thinking in those terms about a coworker, no matter how much I liked her. Read more on Burning Out On The Job…

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She was 32 and she looked tired.  She told me she had been abused in childhood.  A general physician whom I trust and who does a good job had sent her to see me, thinking she could be a little more relaxed and doing better with pharmacology.  We had not even talked about what kind.  This young woman was not sleeping well.  She made the interview easy as she already knew her diagnosis – post-traumatic stress disorder (PTSD).

Informed ConsentShe said the abuse had been both physical and sexual.  She still had an occasional dream or daytime thought about it.  She did her best to avoid the people who had done these horrible things to her.  Also she was “high strung.”  She confirmed that she tended to hyper-react to loud noises.  “I jump ten feet in the air,” she said.  So she had the three hallmarks of the diagnosis.  I am a woman with little faith in colleagues, so I always confirm the diagnosis.

I noticed, to my horror that the only medication she was receiving was Klonopin, also known as clonazepam, a half mg. twice daily.  Now she had been on nothing but this for many months.  I have a lot of troubles with drugs of this class: they are addictive, abusable, and at higher doses, which many people take sometimes, they can cause shakes or even seizures with withdrawal.  If she ever skipped a dose she would feel it.  Besides, they are central nervous system depressants, so they can actually cause someone go get more depressed. Read more on Informed Consent Is Your Legal Right…

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