Sunday, September 30, 2012

Small Perspective

This is a note about how important it is as a therapist, or anyone really,  to understand the perspective of the person with whom you are interacting.  But actually, this is just a chance for me, as a grandfather, to boast.

The older of my two grandgirls is now22 months old.  She has been walking for a while and is now talking in sentences and some short paragraphs.  She is also so cute that it should be illegal, but that's me, and I hope every grandparent feels that way.

All summer she was walking around, and being at her level, which is pretty close to the ground, she began to notice that the feet of many people, especially the women, were exposed.  It was even more fascinating to her because most of their toes were painted in bright colors.  She was just learning to recognize which color was which, so she would walk around, point to the toes and say "red toes," or "pink toes."  She also seemed to be intrigued that toes came in different sizes, so she would point out everyone's big toe.  "Daddy's big toe."  Pop-Pop's big toe."

But now it is autumn.  People have stopped wearing sandals or flip-flops and have put their shoes back on.  My granddaughter seems to find this a bit confusing.  She was really enjoying checking out all those toes, and now they are gone.  Now she goes around, points at the shoes and say: " Pop-Pops foot hiding." "Nanny's foot, hiding."  This has generalized to other things, such as "belly button, hiding."

So, you see, if you took that out of context, you'd think she was strange.  But if you understand the perspective of the person, it can all make sense.

ALSO: on setting limits:

The other granddaughter just celebrated her first birthday.  Her uncle gave her a big red, blue, yellow and white clown as a present.  The clown is about twice her size, but she is in love.  She grabs the clown, shrieks, jumps on it, bites it, rolls on it, laughing and screaming with delight.

But I told my son, her father, that if she continues to spend her time with a clown like that, I'm not wasting money on her college education.  Someone has to point out what's good for her and not let her waste her life.  I've seen that happen too many times to not take action.

Monday, September 24, 2012

no diagnosis?i

I recently began seeing a new person for therapy.  He is a tall, handsome man, which adds to his problem.

His problem is that he likes sex.  That is not so unique to him, but he takes it to an extreme.  He thinks about sex a lot.  The idea seems to cross his mind with almost every woman under 80 he sees.

That may not be so unique.

What is unique is that he often acts on his wishes, and has a great deal of success in meeting his needs.  His wife is mostly accepting of this, as are the women.  The trouble is that he has run afoul at his work, in his neighborhood, and with others who have to deal with the atmosphere he creates.

He is now in danger of losing his job, his marriage, and of being dismembered by several men who were involved with some of the women he became involved with.

So I went to give him a diagnosis.  I was looking for some kind of impulse control disorder related to sexual impulses.

But it's not there.

There are sexual dysfunctional disorders, but they area all about NOT being able to have or enjoy sex. Having too much is never seen as a disorder.  There are diagnoses for fetishes, for sadism and masochism.  But he is not like that.  he just likes getting laid.

There is the diagnosis called paraphilia, but that is mostly a fancy name for necrophilia, which is sex with dead people.  that's not him either.

too much sex, not a problem.  Except for him it is.

Diagnosis:  312.10:  impulse control disorder, NOS

Sunday, September 16, 2012

A life of the Times

My life seems to have melded with the current way of being.  Information, tasks, people, roles, ideas, news, opinions, all pour in constantly, with no interruption.  There are times when I can't really tell if a thought comes from something I just read, something someone told me, or was actually an idea of my own.

Often, it feels as if my life has been divided into several separate segments that barely overlap.  My work life, sitting in my office, seeing my patients, wondering, thinking, planning what to do for them and how. this has gone on for over thirty years.

My family, which has been with me even longer, has changed greatly over time.  I am still a husband, but now with a wife who wants to ease into the next stage of life.  I am a father, and now a grandfather, which is a very different role, with very different expectations, responsibilities and really, a very diminished amount of authority.

It is also much easier.

I have friends and activities that are further and further away from work, as many of my friends have eased up, or have stopped working.

I have a life of ideas in my head, especially since I have begun to think about the talk I will deliver, which I find interesting and stimulating, and which is putting me in contact with totally new ideas and new people.

It is all very busy, which is good.  It gets confusing, and difficult to prioritize, but I can work it out.
the main thing is to keep going and stay healthy.

And also not to get upset by a missed field goal as time expires.

Wednesday, September 05, 2012

new direction

As I said, I am gearing up to give a presentation at the state psych association conference.  I am going to talk about how technology could change the delivery of mental health services by 2020.  I have been thinking about how there can be more mobile monitoring, more use of direct, real-time measures of change.  There can be immediate therapist/patient contact through texts and apps.  Lots of new things can be introduced.

For years I have talked about how psychotherapy remains one of the few low-tech professions.  A good part of why it works is due to the  face to face building of trust in an interpersonal relationship.  I still think that is important, but there are so many new ways that the relationship can be enhanced by using technology.

What I notice now is how restless I get using the old traditional, one office visit per week.  I have begun to text some of my younger patients, and they seem to respond.  There could be so many other things that could be used.  I am already eager to see it all begin.

I'm sure many people do not agree, but eventually, they will all die off.