Why I am not always the best Therapist

In some ways I'm not the best therapist for today's conditions.  That's not why I am slowing down, I have another seventeen reasons for that, but it seems to be true.

Sure, sure I can see a lot of progress in the people I see in therapy.  About 45% do well and I push them out after a year or so and their lives are easier, happier and they function better.  Another 35% do REALLY well, and they come up from the depths of torture and despair and put something together like a relationship or just happiness and that makes me feel better.  Another 20% don't.

But, as I said in my last post  (you can click back and read it, if you haven't already), the world, especially work, is much more fast-paced and stressful than it was when I opened this practice of psychotherapy.  For many of my patients I find that part of what we do is strategize how to deal with that stress -- not just breathe deeply, but how to prioritize, how to deal with a bad boss, how to deal with the huge, constant demands that a corporation. large or small, places on an employee.

Years ago, in the 90s, when managed care was clearly going to continue to be an intrusive pain in the ass, even before they began reducing fees, I decided to expand my revenue base and do some direct consulting to some local businesses. One was to a company that made stuff, and another was to a local financial services company.  My job was to help higher, but not top, management make their employees more productive.

Well, the company that made stuff, made some real crappy stuff and treated their employees terribly.  The financial services company had a business model that was either just this side or just over the line of being sleazy.

In my head, although I didn't actually say it, my best advice would have been to get the hell out of that business.  I didn't do much consulting after that.

I often still feel that way when I deal with my stressed-out patients now.

But I also realize that they don't have too many choices, and having and holding a job is very important these days.

But since I left working at a community mental health center in 1981, I have not had a boss. I set my own hours.  No one really tells me how to work, although I do consult and collaborate. Insurance companies set most of the payments I get, but at least I don't have to deal with the worst of them.  Many of my colleagues don't take insurance payments at all.  I didn't want to go that way, but it was my choice.

Whenever I see an opportunity I try to encourage people, especially younger ones, to try to do their own thing, build their own business, do something they want to get up and go and do.

But that isn't easily done, especially if you are part of a family that needs to be supported and given some stability.

But it's tough to see so many people feeling so much stress, and having so little control of it.
A lot of them are much better at it than I ever was or will be.

Big Data 2

Yesterday:  A couple of my patients were talking about how stressful and how constant their jobs were.  Later I met with a few of my colleagues for our annual gathering and we joked about how much money we weren't making.  Most of us can track at least a 20% fee reduction from insurance companies over the last eight years -- beginning long before Obamacare.

Part of the reason work is stressful is the result of how we live in a global economy and many jobs, from running a chain store to developing software to track weather satellites, is often done by teams from all over the world who work together virtually.  That means that someone is always working on it, and everyone is always part of the process, so everyone is "on" almost all the time.  Another reason, and here we begin to get into Big Data, is that costs are tracked all the time too.  Data comes from everyone's computer about who is doing how much of what.  It becomes clear from the data when someone's job is no longer needed, then they can be cut, just like turning off a machine.  It makes it easier because the person who cuts someone else out of the job has no real idea who that person is because they may be working a thousand miles away and not across the hall.

Then because people get cut so easily everyone knows that jobs are not only hard to find, they are hard to keep, so just having a job is a good thing.  That means the employer won't have to pay as much because people want to work, and people know they can be replaced easily, either by someone else looking for work, or else by a machine that won't complain.

Because so many people work in ways that are connected to some kind of electronics, whether it is a big office workstation, a hand-held box scanner or a GPS, all kinds of data about how fast people work, who follows rules, who creates better methods and who creates trouble is monitored and algorithms are developed to pick out the "good" workers and weed out the "bad" ones.

The pressure to get something done seems much more intense than it was ten years ago, and certainly much more than it was twenty-five years ago, pre-email, when you could go home from work and not have constant up-dates.

The pressure is great, but to what end?  Most jobs seem to be help business get get better organized so that they can sell me stuff I don't need and probably didn't ever think I wanted.  Most airplane travelers are business travelers who travel to help businesses run other business to make something, somewhere that someone else will sell to me.  While they are traveling they go to hotels and restaurants and use cars and use business machines to keep in touch and to track how they doing, and how much gets made and sold.

It all seems to go around and round.  It creates a lot of stress, but it gives people jobs so that they can have families and buy stuff for their families, which keeps the businesses going

Now everything everyone buys is tracked and priced and that allows someone to advertise to whoever bought what they did to buy more of it, quicker and maybe cheaper.  Which is good because I just got a $900 sweater for $9.99, and if I buy another I get another one free, but I don't need three sweaters, but I  may some day.

Should we sorry about this?  Should we get off the grid?  Keep all our data private, away from the NSA, and Google and Amazon and Macy's and Walmart and Target, or should we just buy another sweater and keep it all chrunning along?

And it's been three years and the US hasnt started a new war.

Back at work

I took three weeks off and came back yesterday. 
Being off was more difficult than I thought.  That is not a good thing.

Part of the problem is that we went down to the beach house and opened the doors and people poured in. All good friends, some we hadn't seen for years and others from around the corner.  Most stayed for a night, or two or three, even four.  It was great to see everyone but it was not the way I usually escape, which is to sit and make sure the tide is on schedule and not talk to anyone.

But that was only part of the difficulty.  The other part was that, while most of my friends are doing quite well, many of their kids are not. This seems to be common, and distressing and too much like work, except that I can't do much about it. 

These "kids" to which I refer, range in age from 24 to 38.  One needs an operation and had to scramble to get health insurance.  Another probably has the early signs of a chronic, debilitating disease.  Those situations are distressing.  But even more common are the kids who are struggling to find a decent job, to grow up and be independent.  The problems are much more economic than psychological, but they become psychological, and are very distressing to their parents. 

What becomes worse is that these kids either don't get married, because they can't afford it, or the marriages are falling apart, to a large extent because of economic pressure.  When the marriages fall apart many of the kids come back to their parents.  Many of them bring their very young children.


This is not good -- not good for the grand-kids, the kids or the people my age.  It's not good for the country or the world.  It didn't help the vacation.

Back in the office, I began seeing the patients I had been away from for three weeks.  I wondered if my business would last or if the recession would change things even for me.  But today, the second day back, I got several calls from people looking for help.  The issues they want deal with involved themselves and their grown or almost grown kids.  They needed to find their way in the world; they needed jobs, AND, to fight the boredom and depression many of the kids between 16 and 26 have been taking Percs and Oxys to ease the pain -- the psychological pain.

Things are not good out there , and once families begin to struggle the drop in quality of life can be swift and steep.  

This is not good.  But at lest in my office I can try, at least try, to do something about it.