3 Reasons to Be Tired

#1.
I can tell I am getting tired.  It seeps into my body, my mind and my soul.  This is part of getting ready for vacation, which now is just a week away. To go on vacation it is necessary to be tired.  A vacation should be earned.  For me, it is difficult to just walk away because you can; you have to be tired.

So I am getting tired.

#2
It seems like many of my colleagues are tired also, and a bit scared.  They can see that the landscape is changing.  This whole health care delivery discussion makes everyone wonder what's going to happen.  It is reasonable to assume that those who will be making the decisions will have no idea what they are really talking about -- on a therapist to patient level.  The decisions will be based on money.  Those of us who still bill insurance companies for our services have already seen that the way insurance companies will cut costs is to pay us less. 

The other way will be to not pay us at all.  The model that most psychotherapists use, seeing people in their office for about 50 minutes at a time, once a week, was created about a hundred years ago.  It hardly fits today's world.  Two things are happening.  Well trained, Ph.D, or M.D. therapists are being replaced by Master's level people who are paid less.   Also, technology will enter into the mix.  People will be treated by text messages and Tweets. How much does it matter?  I think it does, but it is very difficult to demonstrate. I am the best therapist in the world and I only help about 62.347% of the people I see.

All of this makes everyone discouraged, and tired.

#3
When I'm rested and on the top of my game, doing therapy is challenging and fascinating. When I begin to get tired I can feel the resistance.  I can still deal with it, but it is there.  What happens is I feel badly when I open the can of worms and really see what's in it.  Today I was working with a guy I have been seeing for about six weeks. I like him.  He is bright, interesting and came to me for anxiety problems.  I am good with anxiety problems, especially if they are , you know, anxiety problems.  But they are not always just anxiety problems, very often they are more than that. It can take a while to find out.

Today, I was doing what I do, which is when someone with anxiety is still just as anxious even after I have sprinkled the first wave of magic dust on them, I probe a bit to find out what' s going on. Now, this is a guy I really like, as it is with most of the people I see.  When I like them I don't want them to be too fucked up.  But I still have to look under the rocks and see what's ticking.  So today, I looked under the rock and found out the the guys isn't just anxious, he's full of self-loathing and has cut himself.

I was tired.  I didn't want to find this out.  I want him to be OK.  I wanted it to be easy.  I can handle it, but then I'll go on vacation.  Now I have to do things to make sure he's OK.

It's not that I'm complaining, because this is what my job is.  It's just that I'm.......
complaining.

worse than it is

Today is Monday, and somehow on Monday I see some of the most difficult, most chronic people that I have to deal with.

I have been practicing in this city for twenty-seven years. I began here the month after John Lennon was killed, so it's easy to remember.

In a practice like this each year I see between 150 or 175 different clients. Usually, about 50 to 60 get carried over to the next year. After 27 years I have learned that the average length of time that anyone spends in treatment with me is bi-modal. It is either six months or eighteen months.

But every year I get one or two people whose lives, or whose minds, are a mess. They stick around for a while. After a while they begin to accumulate.

Today it seemed like everyone I saw was someone I had seen forever, and that I would see until the day I died. But that isn't true.

I checked my records and found that of the 66 people I have seen this year 17 of them I have seen for five years or longer. That is 1/4 of all the folks I see. By the end of the year I will have about 100 people will have finished therapy. But not these folks.

I checked further and noticed that five of those 17 people account for 58% of the phone calls I get.

They are troubled, in constant crisis, some are more than a bit narcissistic, need guidance, reassurance, attention, and seem to have some sense that having a therapist means having a super-mother with a huge breast.

It is these people that have driven some of my colleagues out of business.

I try to set limits. They now know that just because the leave four messages doesn't mean they will get a return call. Life goes on.