Showing posts from June, 2006

Do therapy docs really listen?

In Try Sitting in My Chair the book I've never tried publishing but will one day, okay?-I tell a few anecdotes to make you never want to become a psychotherapist. Anyway. It's true that we shrinks sometimes feel a little crazy at the end of the day, having listened to so many problems. I'm the type who cranks up the radio really loud after work-- and it doesn't matter what's on, not initially. Anyway, I say that because so many people have asked me how it is I still do this job, day after day, week after week, month after month, year after year. I'm not so young anymore. One day, many years ago, I met an elderly psychiatrist in the hallway of the building where I worked. Dr. K and I were locking up, leaving at the same time. He must have been in his eighties, tall, skinny guy with thin white hair. I asked him the same question. Dr. K.? How do you do it? Day after day, week after week, month after month, how do you sit and listen to so many problems? He turned t

Evil Step-Mother-First Installment

EVIL STEP-MOTHER Here's where we take off the gloves. I'm going to try to be fair, but as always am biased by what I've heard people talk about in treatment. In this case it's the hundreds of stories (100s?!) from people who have cried about the terrible pain and abuse they've suffered from the evil machinations of STEP-PARENTS. I've talked to men and woman who remember violent beatings, emotional torture, and sexual indiscretions. More horrible stories about STEP-FATHERS, frankly, than about STEP-MOTHERS, but I'm willing to acknowledge that my sample isn't representative. (Hey, the PhD was worth something). Anyway, it's safe to generalize that health professionals get to hear every conceivable combination of horrendous parenting behaviors known to man. (And you envied us our in-roads to the human psyche, all that talk, all that gossip. Maybe my friends were right about switching to real estate.) Being a therapist can be freaking traumatizing at time


This is less about self-medicating with marijuana than it is about how complicated and unmanageable emotions can be. One day it's depression, the next day anxiety; one day we're manic, the next day obsessive-compulsive. We get the symptom of the week, too, whatever we read about on the Internet, hear about on Oprah. We’re complicated organisms, humans. This conversation isn’t fiction, I’ve had it many, many times. PATIENT: I don’t know, doc. I’m feeling pretty down, pretty sad. And summer’s my happy season. This is going on for too long. I lost my job. Life sucks. THERAPY DOC: (At the risk of sounding trite, stroking chin). How long would you say you've been feeling like this? PATIENT: I don't know. Maybe three months, maybe more. THERAPY DOC: Sad. PATIENT: Yeah. I'm depressed. Everyone's noticed, too. THERAPY DOC: Excuse me. But I thought that on the phone you said you wanted help with an anxiety disorder. You don’t look or sound very anxious at all. PATIENT


Dear Therapy Doc, My eight year old seems to be a chronic liar. It doesn't matter what I ask him, he either makes no sense or is clearly not telling the truth. He looks me right in the eye and lies! Is he a pathological liar? How do I break this habit? In answer to your question, we don't hit him when we punish him, we give him a time out. I was giving him a time out every time he lied, but he didn't seem to mind, so now I just shake my head and say, "I know you're lying" and walk away. But he's still lying. And now it's getting to be a sort of a power thing. He'll dig in his heels and say, "NO I'm not," and smile. Telling the truth is a big thing for me so I am Feeling Like a Failure Dear Feeling Like a Failure, Some family docs would say that there's someone ELSE in the family who is lying, too (like a spouse or other sibling) but I'm going to assume that it is not that and give everyone in your family the benefit of the dou

Co-dependent, never say no, and he needs me

I used to try to find songs that represented co-dependency. My favorite was from the musical, Oliver. Remember this one? As long as he needs me I know where I must be I'll hold on steadfastly As long as heeee neeeeeds meeeeee. As long as life is long I'll love him right or wrong And somehow I'll be strong As long as heeeeee neeeeds meeee. When you are lonely, then you must know If someone needs you, you love them soooooooo I won't betray his trust. Though people say I must I've got to stay through JUST As Long As HEEEEEEE NEEEEDS MEEEEE!\ Okay, people. If you've been reading me thus far you probably get that this sort of thinking gets me thinking. It's not so good. Living life because someone needs you isn't a life. You actually have one that is far greater than care-taking someone else's, although it is noble to help others. You're worth something even though someone needs you. Identity is threaded with one's job, values, position in yo

Blood is thicker than water.

Sometimes people ask me whether or not they should marry a certain someone. All I can do is predict what will happen in a marriage, based upon what a patient tells me, and help determine whether or not it's worth the risk. There are certain obvious traps, however, and depending upon how many balls we are juggling and whether or not dropping a few will make a difference, the traps can be insurmountable. Here's one. Susan is an American girl, brought up by working class Protestants, British descent, and Lawrence is an Iraqi from a wealthy family. It doesn't matter. She could just as easily be a Latina, a Jew, or a Christian. And he could be Caucasian or Puerto Rican. They could both be Mexican; she could be Swedish and he could be Muslim from Turkey. What matters in this case is that Susan's fiance could not put her before his son, Moudi. She had moved in with them and was doing most of the domestic chores. Moudi, 24, belittled her and messed the house after she cleaned.

Gone Postal

Just so you don't think that being a therapydoc is all about manipulation, glamour, and a little heart to heart, I'm going to tell you a story. This one's about a guy, a new patient who had walked into my office a few years ago and SCARED THE LIVING (sic)DEATH out of me. All of the details have been changed to protect his identity, but I think you'll get the idea. He wasn't tall, but he was brawny and tattooed, sweaty (it was summer) and unshaven. He wore torn cut-offs and a wife-beater tee-shirt. He had a piece of gauze taped over his wrist, and I knew what that meant. He sat for a few minutes with his head in his hands, staring at his shoes. His head was large and his hair greasy. I chilled. After what felt like forever he looked up at me and said, "My wife's leaving me so I want to die. Just this morning I tried to kill myself., Want to see?" Uh, no, that's okay, I'm thinking, but I don't answer. Then he proceeds to unwrap the gauze (tha

Confidence and Social Phobia

Once titled Confidence Game, this post is under revision for the book. I'll repost it when it's ready, but it could take awhile, and I'm not sure if that's even a good idea. What do you do when you can't decide? therapydoc

Religious nut? Or not.

Religious nut or not, that is the question. There is very little about religion in the DSM IV except that clinicians are supposed to understand a person's world view/culture before assessing pathology. Ideas of reference (God talks to me) are considered pathological. Mainly, we don't believe that God is talking to people directly via our thoughts or over the telephone lines. When a patient believes that he or she is in direct communication with a Creator that is telling him to hurt himself or someone else, we worry about psychosis, that indeed, there is potential for danger. If God is telling you to take your own life or that of someone else's, well, who are you to object? So we worry about ideas of reference as they are sometimes characteristic of some of the more the severe mental disorders. But for many people, being in touch and having talks with God is not weird, dangerous, or pathological. Some people are simply very spiritual, very sensitive to what they see

Bi-polar Disorder: Not everyone has it, actually

Bipolar Disorder, Manic-Depressive Illness The diagnosis of the year. Never before have so many patients told me they think their partner, brother, sister, mother, in-law, uncle, first cousin once removed, just about everyone or anyone they know is for sure bi-polar. It's good that there's so much awareness of the disorder, perhaps due to the media, especially talk shows that cater to the therapy-craving public, sensationalizing mental illness. But I feel there has to be more clarification, a little polish here, for the benefit of those who never had the chance to go to grad school. The bi in bipolar refers to the two poles of the disorder, ends of a continuum. Symptoms of these end-points range from manic, as in spending much more than one has to spend, driving too fast, craving sex all the time and not being 17, to depressive, often wishing you could dig yourself out of a deep, dark, pit and sleeping most of the day and night. Having features of only mania or only

Learn to Listen-- About Kids

Parents tend to talk a lot. They have a lot to say, face it, years and years of words building up inside. And kids, well, they’re helpless, captive. What a position of power it is, being so much taller, so much better at words, knowing so much more of life and love, anger and madness, right and wrong. Those of us without verbal skills may not say anything, might even over-look a child’s errant behavior. That’s sometimes called benign neglect. Or, worse, they succumb to bullying or unfair, unreasonable disciplinary tactics (usually poorly executed) that alienate the child. Kids, as they grow and become more confident, can make fools out of us, force us to play a hand that's already been played unsuccessfully many times over. But even when it feels like we’re losing, we’re really ahead. Why? They need us to love them and approve of them and their choices, as insane as those choices sometimes seem to be. (The best blog, by the way, on parenting and giving kids healthy

Listen Silly, Part One

Alternative Universe Listening to a child, parent or spouse is basically like entering an alternative universe. That's what it's like trying to understand someone else, generally, whether we realize it or not, it's another world. Lucky for us, we’re usually invited in. People want to talk, especially about themselves. LISTEN SILLY #1 therefore presents a few general principals. Future posts will specify by listening topics— listening to your partner, your kid, your parents, your friends, your boss, your horoscope, (nah, not really the horoscope part). We’ll talk about getting into another person's world in general right now. It isn't easy living in or visiting someone else's universe, but it's cheaper and easier than flying American these days. If you need a hearing aid, by the way, consider the investment. The digitals rock. Let's begin. On a popular TV show, Star Trek , there was a psychologist. Troi, I think was her na