Black Holes

Sometimes I do answer your questions.

A reader tells the story of a relative who had been dumped by her therapist because she had a certain personality disorder. The reader queried her own therapist about this and her therapist is said to have said:

Some (personality disordered) folks can be black sucking holes. That therapy would go on for a lifetime if her therapist let it.

Therapydoc, our reader asks, have you ever had to tell a patient, There's nothing more for me to do. If so, how did that go?

And secondly, when you have a person who is a woe is me victim, can you generally see through that? These are the people for whom trouble follows. They tend to create their own trouble, strange as that may seem. Have you run into one of those and how do you deal with that?

Hey not to tell you how to run your own blog, but that might make an interesting post.

I once had a feature like this, answering reader questions, way back in the archives. Like most of my ideas, it lasted a week, for sure.

Have I ever told a patient that I've gone about as far as I can go?

In the State of Illinois, after six months of treatment, if a patient isn't getting better under a social worker's care the social worker is legally mandated to punt to another therapist. I'm not sure how the other mental health professions handle this, but social workers can't let you malinger very long.

Although six months can feel like a long time.

My style is to evaluate how therapy's going relatively often, being of the empirically-validate-your -therapy-or-you're-a-quack generation. If you have no idea what I'm talking about, don't be surprised. Therapy is usually predicated upon what the patient brings to the table, not evaluating progress. Evaluating outcomes for a treatment's intrinsic empirical value is nice in theory, but impractical.

Unless you're a behaviorist :) in which case you do it all the time.

Therapist: How many times did you shower this week?
Patient: Seven times!
Therapist: Feels great, doesn't it? (writes in notes, patient is caring for hygiene, showered 7 times. Looks a whole lot better, too).

But at the six month mark, no matter what kind of therapist you are, you're really supposed to take a good look at what's going on and decide if your patient might benefit from another doc's approach. I'll say,

We have to discuss how we're doing, seriously, in this treatment, because I'm legally mandated to make sure you see someone who will help you more than I can if I'm not doing a very good job.

Incredulity. YOU ARE????

Uh, huh.

Wow. Maybe I SHOULD see someone else!

Exactly.

But usually we talk about it and set a few goals and reevaluate our progress in four weeks time.

As to patients for whom worries follow, who seem to invite trouble and suffer from interminable aggravation. Am I onto them? Do I know their game?

Game? What game? This is surely justification to stay in therapy.

I tell patients who have one problem after another, As long as you need to be sick, you should probably be sick. One day you'll get sick of me, too, and sick of therapy. But if you aren't sick you can still come and see me, you know. As a matter of fact, I'm pretty sure we haven't covered 1979-1985* yet.

And those had to have been hellacious years.

therapydoc

*Fill in the proper years/gap.
The director of a very prestigious managed care group in Chicago now defunct) once told me, Whatever you do, make sure you keep 'em coming back. (tongue in cheek)