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.
Sunday, September 30, 2012
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.
Interesting.
too much sex, not a problem. Except for him it is.
Diagnosis: 312.10: impulse control disorder, NOS
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.
Interesting.
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.
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.
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.
Monday, August 27, 2012
Presentation
So, I am going to do a presentation at the local state psychology conference this fall. I am going to talk about how we psychologists will measure changes in 2020. That will be fun.
A lot of whatt I will say I have said here -- how technology will change everything. We will use apps. We will use real-time monitoring. I think it could be exciting and much more effective.
Right now I think it will be more fun to design it than to do it.
Let's see how it goes.
A lot of whatt I will say I have said here -- how technology will change everything. We will use apps. We will use real-time monitoring. I think it could be exciting and much more effective.
Right now I think it will be more fun to design it than to do it.
Let's see how it goes.
Thursday, August 16, 2012
Men -- Fictional
I don't read novels very often. I'm even in a men's book club, and we don't read novels -- I guess that's for mixed company. But it's summer and now that I'm on vacation I have read two novels in the last week. They have certainly helped me see what has happened to American men.
The first book I read is by a man I respect and who is one of America's major novelist of this century, Dave Eggers. I read his first book, and even though I was a bit confused by it for a while, I liked it -- and it wasn't even fiction (mostly). The book I read this week is a Hologram for the King.
Then, while wandering around at a local town book sale I bought a book by Louis L'Amour, one of those about the Sackett family.
Louis L'Amour wrote 89 novels beginning in the 1950s and going until the late 70s, most of them westerns.
Well, the men in these books could not be more different. Mr. Eggers' hero, Alan Clay, is constantly full of anxieties and doubts. He is hesitant, impotent, and indecisive. He is plagued by thoughts of his ex -wife, his father, his daughter whose tuition he can't pay, the job he lost, the job he has, and his place in the world.
In complete contrast to this, all Mr. Sackett needs is a horse, a rope and a gun and he can solve any problem, sort out any situation, with the clear knowledge of what is right and what is wrong, and with very little concern about who may get killed along the way -- as they were obviously wrong. No issues of self-esteem are even conceivable.
The American male, and his place in the world has changed a great deal during the past 50 to 60 years. The world is much more complex and enmeshed.
However, there are many, many people ho do not want to acknowledge this. They want to believe they can live the way Mr. Sackett did. Most of the stories Mr. L'Amour wrote took place in about 1871.
Things are different now.
Better? That's for you to decide.
The first book I read is by a man I respect and who is one of America's major novelist of this century, Dave Eggers. I read his first book, and even though I was a bit confused by it for a while, I liked it -- and it wasn't even fiction (mostly). The book I read this week is a Hologram for the King.
Then, while wandering around at a local town book sale I bought a book by Louis L'Amour, one of those about the Sackett family.
Louis L'Amour wrote 89 novels beginning in the 1950s and going until the late 70s, most of them westerns.
Well, the men in these books could not be more different. Mr. Eggers' hero, Alan Clay, is constantly full of anxieties and doubts. He is hesitant, impotent, and indecisive. He is plagued by thoughts of his ex -wife, his father, his daughter whose tuition he can't pay, the job he lost, the job he has, and his place in the world.
In complete contrast to this, all Mr. Sackett needs is a horse, a rope and a gun and he can solve any problem, sort out any situation, with the clear knowledge of what is right and what is wrong, and with very little concern about who may get killed along the way -- as they were obviously wrong. No issues of self-esteem are even conceivable.
The American male, and his place in the world has changed a great deal during the past 50 to 60 years. The world is much more complex and enmeshed.
However, there are many, many people ho do not want to acknowledge this. They want to believe they can live the way Mr. Sackett did. Most of the stories Mr. L'Amour wrote took place in about 1871.
Things are different now.
Better? That's for you to decide.
Monday, August 06, 2012
Before I go
I am leaving for a few weeks away. It is August after all, and enough is enough. I expect it may give me more time to scribble things here, or perhaps I will just calmly float away and not be disturbed by anything.
One word before I go. A lesson I learned a long time ago, continues to prove itself over and over.
Never ask a human a "why" question, especially about his/her own behavior. It's great in science to ask "why" of the world and the universe, but if you ask "why did you do that?" or really --"What the fuck were you thinking?!?! The answer you get will be meaningless, distorted and wrong.
It's the job of the therapist to figure out the motivations, causes, and conditions that precipitated the action. Then, together, you can figure out what to do, and how to make that happen.
Yes, it is often interesting to hear the reasons people think up to explain what they did. Sometimes the reasons are very clever, and can cover a lot of ground. But it's all in hindsight, and it's usually only to make the person feel good, or at least rational.
But we know better.
Now, why did I write all this?
One word before I go. A lesson I learned a long time ago, continues to prove itself over and over.
Never ask a human a "why" question, especially about his/her own behavior. It's great in science to ask "why" of the world and the universe, but if you ask "why did you do that?" or really --"What the fuck were you thinking?!?! The answer you get will be meaningless, distorted and wrong.
It's the job of the therapist to figure out the motivations, causes, and conditions that precipitated the action. Then, together, you can figure out what to do, and how to make that happen.
Yes, it is often interesting to hear the reasons people think up to explain what they did. Sometimes the reasons are very clever, and can cover a lot of ground. But it's all in hindsight, and it's usually only to make the person feel good, or at least rational.
But we know better.
Now, why did I write all this?
Thursday, July 26, 2012
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.
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.
Tuesday, July 17, 2012
I am OK -- but..
I am OK. In fact I am doing surprisingly well. This has been a great summer. I am in good shape and healthy. My eye is better, my knee is better. Nothing really hurts. I have been very active kayaking, biking and chasing my grandgirls -- only one of whom can actually walk, so it's not that hard -- but the one who can walk loves to run away.
I like hot weather, so the summer has been good to me. We go off to the beach house and play.The kids have been coming and bringing their kids. Friends have been coming. We discuss how the world is falling apart while sitting in great comfort.
Then I go to work and things are different. but that is the nature of what I do. People very rarely come to me to tell me how happy they are, or how excited they are about the interesting, creative, fulfilling things they are doing. That happens occasionally, but that means it is the last session.
But I have been doing this for years. I can deal with depression, even terrible depressions. Anxiety; hey, everyone I see is anxious, also I can be helpful for loss, loneliness, confusion, stress, relationship problems, addictions, even violence. Hey, let's talk about it. My kind of therapy at least doesn't have side effects. It won't make you constipated or gain weight.
But you know what upsets me. Dealing with people who have chronic, physical pain. I mean pain that has lasted years and comes from degenerative diseases. Diseases that not only resist treatment, but that the treatments for them seem to create other painful conditions. The drugs lead to passing out, or digestive disorders or kidney failures. Pain raises blood pressure, the drugs for that causes dizziness, people fall down, cut themselves and go to the hospital and pick up a staph infection. The antibiotics for the staph infection cause colitis, which leads to a colostomy. But still the pain, from the degenerating bones, or the pressure on the nerve from the back injury, or whatever it was that began the whole process goes on, and no one can really find it, and if they find it they rally can't do much about it.
Part of why it bothers me is that I am getting older, my friends are getting older and my clients are getting older. For me, I can no longer run and jump. For me, who played basketball for 25 years with the same group of guys it is a loss. But I can cope.
What i know is that more is coming. More of my friends have had knees replaced, hips and shoulders too. They are on all kinds of meds because this or that number comes up too high. I take one little pill. Other friends have stents in their bodies, or have difficulty getting out of chairs, or even, are dead already.
So far, most of my friends and family are basically OK.
I plan to be immortal, until I am dead.
I like hot weather, so the summer has been good to me. We go off to the beach house and play.The kids have been coming and bringing their kids. Friends have been coming. We discuss how the world is falling apart while sitting in great comfort.
Then I go to work and things are different. but that is the nature of what I do. People very rarely come to me to tell me how happy they are, or how excited they are about the interesting, creative, fulfilling things they are doing. That happens occasionally, but that means it is the last session.
But I have been doing this for years. I can deal with depression, even terrible depressions. Anxiety; hey, everyone I see is anxious, also I can be helpful for loss, loneliness, confusion, stress, relationship problems, addictions, even violence. Hey, let's talk about it. My kind of therapy at least doesn't have side effects. It won't make you constipated or gain weight.
But you know what upsets me. Dealing with people who have chronic, physical pain. I mean pain that has lasted years and comes from degenerative diseases. Diseases that not only resist treatment, but that the treatments for them seem to create other painful conditions. The drugs lead to passing out, or digestive disorders or kidney failures. Pain raises blood pressure, the drugs for that causes dizziness, people fall down, cut themselves and go to the hospital and pick up a staph infection. The antibiotics for the staph infection cause colitis, which leads to a colostomy. But still the pain, from the degenerating bones, or the pressure on the nerve from the back injury, or whatever it was that began the whole process goes on, and no one can really find it, and if they find it they rally can't do much about it.
Part of why it bothers me is that I am getting older, my friends are getting older and my clients are getting older. For me, I can no longer run and jump. For me, who played basketball for 25 years with the same group of guys it is a loss. But I can cope.
What i know is that more is coming. More of my friends have had knees replaced, hips and shoulders too. They are on all kinds of meds because this or that number comes up too high. I take one little pill. Other friends have stents in their bodies, or have difficulty getting out of chairs, or even, are dead already.
So far, most of my friends and family are basically OK.
I plan to be immortal, until I am dead.
Monday, July 09, 2012
Back to work
The summer will continue, but for now, I am returning to my office. I did have a marvelous week at the beach house. I did get to go to the beach with my grandgirls, although Elmo stayed at the house. We threw rocks into the waves, we sat on the edge of the water and made splashes. I got to see my children be parents, which is kind of weird, but certainly an experience, and it made me very happy and a little sad (becasue I don't want to be old)..
Now I am in the re-entry phase. I picked up my messages and made several phone calls. I have a lot of appointments this week before I get to go back to the beach. Some of them have already canceled, others have left messages seeking an appointment and they will will the openings.
Also, I have been perusing some of the blogs of my colleagues. Most of those are done as kind of marketing tools. They usually try to spread some psychological wisdom around the Internet. They give suggestions about how to be active in the summer, how to get people to listen to you, how to be more confident, how to daydream creatively, how to daydream destructively; in general how to live your life in a better, healthier way, if you have any time left after reading how to do all those things correctly.
But this blog is not like that. As you know this is the anti-marketing blog. This is where I tell you that I have a very busy week ahead, but there are a few people, a real minority, like 15%, that bother me, and that overshadows my thinking about the folks I am eager to see. Most of the people I see are working hard to change their lives. Many are struggling against "strong headwinds." as our President likes to say about the economy.
But there is this small group of patients are really nuts, and they ain't going to get much better, and they weigh me down. They are the ones who make phone calls while I'm away. They are bad with boundaries, they are bad with time, they make bad decisions and they don't take responsibility and have little insight, and they talk and talk and talk.
I am sure every therapist, especially if you have been in business for a while, has a bunch of these, but they don't seem to talk about them on their blogs.
So, put on a smile, as it helps your neurology, develop a positive attitude, enjoy the summer, be nice to your friends and family, eat only food that is good for you, don't go into debt, exercise regularly, sleep well, don't worry needlessly, stand-up straight, breath deeply, meditate once in a while, think before you act, and break your addictive habits. And don't call your therapist unless you need to change your appointment time.
Now I am in the re-entry phase. I picked up my messages and made several phone calls. I have a lot of appointments this week before I get to go back to the beach. Some of them have already canceled, others have left messages seeking an appointment and they will will the openings.
Also, I have been perusing some of the blogs of my colleagues. Most of those are done as kind of marketing tools. They usually try to spread some psychological wisdom around the Internet. They give suggestions about how to be active in the summer, how to get people to listen to you, how to be more confident, how to daydream creatively, how to daydream destructively; in general how to live your life in a better, healthier way, if you have any time left after reading how to do all those things correctly.
But this blog is not like that. As you know this is the anti-marketing blog. This is where I tell you that I have a very busy week ahead, but there are a few people, a real minority, like 15%, that bother me, and that overshadows my thinking about the folks I am eager to see. Most of the people I see are working hard to change their lives. Many are struggling against "strong headwinds." as our President likes to say about the economy.
But there is this small group of patients are really nuts, and they ain't going to get much better, and they weigh me down. They are the ones who make phone calls while I'm away. They are bad with boundaries, they are bad with time, they make bad decisions and they don't take responsibility and have little insight, and they talk and talk and talk.
I am sure every therapist, especially if you have been in business for a while, has a bunch of these, but they don't seem to talk about them on their blogs.
So, put on a smile, as it helps your neurology, develop a positive attitude, enjoy the summer, be nice to your friends and family, eat only food that is good for you, don't go into debt, exercise regularly, sleep well, don't worry needlessly, stand-up straight, breath deeply, meditate once in a while, think before you act, and break your addictive habits. And don't call your therapist unless you need to change your appointment time.
Sunday, July 01, 2012
Summer, again, briefly
Wow, it's been a while.
That's becasue it's summer and there is so much to do. so much to do without thinking about it.
Right now I am officially on vacation for a week. Before this I was working days and then taking off whenever I could. Here in New England, when the sun comes out you had better be there because it all ends quickly. It doesn't matter if you're out to get in the water, hit a ball, ride a bike or just take a walk; the time is short. We don't get Spring, except for about three days. It goes from 42 degrees and drizzle to 87 degrees and heat.
Work in the summer is different. There are fewer patients but they are nuttier. Everyone half same takes off and gets outside. The fragile ones go into crisis. It's the heat, the moon, the outside. It's the alcohol, the half naked women, the resentments.
The day before I was leaving I get an emergency from someone I had not seen for three years. Falling apart, laying on the floor of the H.R. office crying. The next day I guy I hand't seen for four years comes to my office ten minutes before my first appointment. He needs to talk.
"Some people claim that there's a woman to blame." And they are correct.
But tomorrow the Grandgril comes, and after Elmo, I'm one of her favoirtite guys. Let's go to the beach.
That's becasue it's summer and there is so much to do. so much to do without thinking about it.
Right now I am officially on vacation for a week. Before this I was working days and then taking off whenever I could. Here in New England, when the sun comes out you had better be there because it all ends quickly. It doesn't matter if you're out to get in the water, hit a ball, ride a bike or just take a walk; the time is short. We don't get Spring, except for about three days. It goes from 42 degrees and drizzle to 87 degrees and heat.
Work in the summer is different. There are fewer patients but they are nuttier. Everyone half same takes off and gets outside. The fragile ones go into crisis. It's the heat, the moon, the outside. It's the alcohol, the half naked women, the resentments.
The day before I was leaving I get an emergency from someone I had not seen for three years. Falling apart, laying on the floor of the H.R. office crying. The next day I guy I hand't seen for four years comes to my office ten minutes before my first appointment. He needs to talk.
"Some people claim that there's a woman to blame." And they are correct.
But tomorrow the Grandgril comes, and after Elmo, I'm one of her favoirtite guys. Let's go to the beach.
Monday, June 11, 2012
Something Good
She was referred by one of my crazier patients so at first I was a bit skeptical. Well, she wasn't exactly referred, she was brought. There they were in the waiting room, so what could I do. I gave her an appointment for the next week.
She is seventy years old, and she looked it, with her slightly unkempt gray hair and leaning on a walker. She could have been eighty. A few days before I was to meet with her I had a session with the patient who brought her. She told me that she was clear that I would never mention either one of them to the other, of which I certainly assured her, but then she told me that she would be coming again with the new woman because the new woman admitted to my patient that she didn't know how to read or write. My patient did not know if the woman would tell me that, at least not right away.
Given that, I didn't know what to expect, because in our brief meeting she seemed articulate enough.
The session began with this new person and the woman told me she had never been in therapy before but she thought she could use some advice. Then she told me that she never learned to read. She said she had been traumatized by nuns. Her parents came from overseas and no one spoke English at home. When she got to school in first grade the nun was embarrassed that she had a student who not only couldn't read, she could hardly speak English. So the nun placed her in the basement of the church and made her copy the alphabet every day. She got no further instruction, but has beautiful cursive handwriting. When she tried to tell her parents what was happening they could not believe that the good Catholic Church would treat anyone that way, and if they did, they much have their reasons. So nothing was done.
In second grade she sat quietly in the back of the class. She thinks that he teachers must have thought she was retarded, but no one ever did or said anything. That remained true until high school. She went to a vocational high school and took up cooking.
At seventeen she met a man four years her senior. He decided that they should have sex. when her parents realized they were doing that they decided they should get married. She married him and had four children before she was twenty-two. She realized that he only used her for sex, and was also having sex with others, so she one day she locked the door and told him if he opened it she would break his head open with a hammer.
He moved to Florida. Only one of her children ever had real contact with their father., and he took that son for a few thousand dollars.
From then on she took control of her life. She opened a catering business that she ran, very successfully for forty years. She had a staff member write the menus, and she didn't need recipes. She raised her children by herself and they are all on their own and doing pretty well. The two who still live close by keep in touch with her often.
She retired five years ago and moved in with one of her daughters. Last year, as her grandchildren were entering adolescence she decided that she did not need to be around the noise and chaos, so she moved into what she thought was elderly housing. The problem is that "elderly housing" in the city where I work is also filled with many interesting and colorful souls, and her hope of hanging out with some nice older women who would talk about their children, cooking and sewing met the harsh reality.
However, before she came to the appointment she had already begun to make some contacts away from the apartment complex, to find some people she may want to spend time with, and to learn how to be polite but distant with those around her. I was able to help her sort out who to see and where to go that could be more enjoyable. She seemed to be very insightful, and we decided to meet a few more times to make sure things work out. I don't expect that anything more pathological will emerge; she was a very unexpected surprise.
She also told me that now that she is alone in her own place, with no one to push her or evaluate her, she is teaching herself to read. She expects to have the hang of it by the Fall. She wants to read that Fifty Shades of Whatever, that her daughters are talking about.
She is seventy years old, and she looked it, with her slightly unkempt gray hair and leaning on a walker. She could have been eighty. A few days before I was to meet with her I had a session with the patient who brought her. She told me that she was clear that I would never mention either one of them to the other, of which I certainly assured her, but then she told me that she would be coming again with the new woman because the new woman admitted to my patient that she didn't know how to read or write. My patient did not know if the woman would tell me that, at least not right away.
Given that, I didn't know what to expect, because in our brief meeting she seemed articulate enough.
The session began with this new person and the woman told me she had never been in therapy before but she thought she could use some advice. Then she told me that she never learned to read. She said she had been traumatized by nuns. Her parents came from overseas and no one spoke English at home. When she got to school in first grade the nun was embarrassed that she had a student who not only couldn't read, she could hardly speak English. So the nun placed her in the basement of the church and made her copy the alphabet every day. She got no further instruction, but has beautiful cursive handwriting. When she tried to tell her parents what was happening they could not believe that the good Catholic Church would treat anyone that way, and if they did, they much have their reasons. So nothing was done.
In second grade she sat quietly in the back of the class. She thinks that he teachers must have thought she was retarded, but no one ever did or said anything. That remained true until high school. She went to a vocational high school and took up cooking.
At seventeen she met a man four years her senior. He decided that they should have sex. when her parents realized they were doing that they decided they should get married. She married him and had four children before she was twenty-two. She realized that he only used her for sex, and was also having sex with others, so she one day she locked the door and told him if he opened it she would break his head open with a hammer.
He moved to Florida. Only one of her children ever had real contact with their father., and he took that son for a few thousand dollars.
From then on she took control of her life. She opened a catering business that she ran, very successfully for forty years. She had a staff member write the menus, and she didn't need recipes. She raised her children by herself and they are all on their own and doing pretty well. The two who still live close by keep in touch with her often.
She retired five years ago and moved in with one of her daughters. Last year, as her grandchildren were entering adolescence she decided that she did not need to be around the noise and chaos, so she moved into what she thought was elderly housing. The problem is that "elderly housing" in the city where I work is also filled with many interesting and colorful souls, and her hope of hanging out with some nice older women who would talk about their children, cooking and sewing met the harsh reality.
However, before she came to the appointment she had already begun to make some contacts away from the apartment complex, to find some people she may want to spend time with, and to learn how to be polite but distant with those around her. I was able to help her sort out who to see and where to go that could be more enjoyable. She seemed to be very insightful, and we decided to meet a few more times to make sure things work out. I don't expect that anything more pathological will emerge; she was a very unexpected surprise.
She also told me that now that she is alone in her own place, with no one to push her or evaluate her, she is teaching herself to read. She expects to have the hang of it by the Fall. She wants to read that Fifty Shades of Whatever, that her daughters are talking about.
Tuesday, June 05, 2012
More American Worries
Went back to work again this week and the more I sit and listen the more I have to worry about. My patients are the least of my worries. They come for help. Most of them have a good idea of what is wrong and they are trying to get their lives together, many from very chaotic situations, crazy families, and a tough economy.
But it is what my patients tell me about what is happening with their families, extended families and communities that worries me more. There is such a growing number of people who are slipping away. There are more and more people who can't function well in this world as it becomes faster and more complex.
Much of it is the result of all the new technology, the globalization, the recession, and the deterioration of families and the educational structure.
There are three kinds of populations that are really not doing well and they have very little hope of improvement. They will become increasingly expensive to society and no one seems to have a real workable approach to solving these problems.
The first group has always been there but now there are more of them; the poor, minorities, unskilled, learning disabled, and left out. These people are now unemployed all over the world. More and more places are looking like India with some very rich people, and many more very poor.
Now there is a second group that had been a rung above the forever under-class. Now there are more mainstream people who had been working but are no longer needed. The older ones, who worked for twenty to forty years in jobs that have been made obsolete by technology, or out sourced, are just lost and depressed. But there are many younger people who never really found a place, never really learned how to work hard, and have kind of faded to the side. They are home playing video games, they are taking too many drugs, they are often angry and causing trouble, they are having children they don't know how to take care of. These are from places and families that were doing OK before, but now many of them can't keep up, can't find a way to really be independent.
There is also a third group that is under the radar, and very difficult to talk about without sounding mean. These people didn't exist fifty years ago, but they do now, and they are very expensive. They are people who would not be alive except for the fantastic progress in medical care. Some of them were pre-mature births, some were from in-vitro multiple births, some were kept alive by amazing interventions, and others have illness that were previously fatal but now medicine can keep people alive, but not really very healthy.
I don't mean to imply that these people shouldn't be alive, or that they don't appreciate all that has been done for them, but there are many more like them who are in pain, have severe learning disabilities, ADHD, and other major handicaps. Many of these people can't work, and they begin to get disability payments and complex, expensive medical treatment at an early age, and while it is good to have them around, and their families mostly love and care for them, it is very expensive and very time consuming.
As of right now, I don't have an answer for all of this. It will probably take more than just me working on it to solve these problems. But they are here, and they are getting worse, and no one is really paying attention to the magnitude of the problem.
But it is what my patients tell me about what is happening with their families, extended families and communities that worries me more. There is such a growing number of people who are slipping away. There are more and more people who can't function well in this world as it becomes faster and more complex.
Much of it is the result of all the new technology, the globalization, the recession, and the deterioration of families and the educational structure.
There are three kinds of populations that are really not doing well and they have very little hope of improvement. They will become increasingly expensive to society and no one seems to have a real workable approach to solving these problems.
The first group has always been there but now there are more of them; the poor, minorities, unskilled, learning disabled, and left out. These people are now unemployed all over the world. More and more places are looking like India with some very rich people, and many more very poor.
Now there is a second group that had been a rung above the forever under-class. Now there are more mainstream people who had been working but are no longer needed. The older ones, who worked for twenty to forty years in jobs that have been made obsolete by technology, or out sourced, are just lost and depressed. But there are many younger people who never really found a place, never really learned how to work hard, and have kind of faded to the side. They are home playing video games, they are taking too many drugs, they are often angry and causing trouble, they are having children they don't know how to take care of. These are from places and families that were doing OK before, but now many of them can't keep up, can't find a way to really be independent.
There is also a third group that is under the radar, and very difficult to talk about without sounding mean. These people didn't exist fifty years ago, but they do now, and they are very expensive. They are people who would not be alive except for the fantastic progress in medical care. Some of them were pre-mature births, some were from in-vitro multiple births, some were kept alive by amazing interventions, and others have illness that were previously fatal but now medicine can keep people alive, but not really very healthy.
I don't mean to imply that these people shouldn't be alive, or that they don't appreciate all that has been done for them, but there are many more like them who are in pain, have severe learning disabilities, ADHD, and other major handicaps. Many of these people can't work, and they begin to get disability payments and complex, expensive medical treatment at an early age, and while it is good to have them around, and their families mostly love and care for them, it is very expensive and very time consuming.
As of right now, I don't have an answer for all of this. It will probably take more than just me working on it to solve these problems. But they are here, and they are getting worse, and no one is really paying attention to the magnitude of the problem.
Tuesday, May 29, 2012
American Dream?
After a very fulfilling, enjoyable, gratifying long weekend spent down at a cottage by the Bay which was filled with what is now three generations of family, I drove to work today and was very aware of the huge difference between the fortunate life that I lead and the lives of many of my patients. On the drive I heard that NPR is going to do a series all summer long about the state of "The American Dream."
I have often told people that the most brilliant thing I have ever done in my life was to be born two years ahead of the Baby Boomers. That meant that when I applied to college, not that many people were applying yet, when I bought a house the big wave of home buyers would follow me and my house would be worth more. My children were two years ahead of most Boomer's kids. I went to grad school when the government wanted psychologists, so they paid me to go --very unlike today. I had enough money to begin to buy stocks in 1979. Although I made a zillions bad stock purchases I did buy MSFT, RIMM and AAPL when they were new companies and that made up of all the losses
( missed GOOG, I have not yet bought FB).
My wife is still good-looking and still a force whose ideas need to be constantly considered. My kids are healthy, employed and already own their own homes. Their kids are round and cute and curious and smiling. We all went to the beach, played golf, had cook-outs. There are always a few ripples in this perfect picture; I only hope they are enough to drive the jinx away.
Every year of the thirty years that I have worked has felt as if our social environment has made my job more difficult. There was AIDS in the 80s, and lots of divorces. There was crack and lots of bad drugs in the 90s, as well as perverted priest and rampant speculation. There have been huge changes in how we live and think which have been brought about by technology. There were the credit card and re-mortgaging binges of the 0's that were a big part of what led to the world financial collapse.
But I have never seen so many people who feel helpless and hopeless when they look to the future. This is felt most dramatically by people in their mid-20s and mid-50s. There are not enough jobs for either of those groups. The younger ones can't get started and the older ones have been tossed aside. The combination of a global workforce, the economic slow-down and technological worker replacement has hurt people not only financially, but in their sense of purpose. It is very difficult to gain any traction in your life when you feel the world doesn't need you.
I do believe that many people will realize that it is foolish to try to jump through corporate hoops and to live your life chasing after money and fame. I believe that eventually many parts of our society will establish a more worthy sense of values that will guide them towards happier more meaningful lives. But I am struck by the number of people, young and old, who are really lost and cannot function well in our new, more complex, more interconnected world. Many young people are lost to video games, Facebook, pot and pills. Many older people, who are still too young for Social Security, seem to be trying to become pathetic enough to go on disability.
Some people feel they were screwed by the system ( and they were). Others really don't know what it means to work hard and take care of themselves. Often, it's the same people.
The American Dream is that things will always be getting better. I think many of us need to decide what "better" means. Then we can figure out how to get there.
I have often told people that the most brilliant thing I have ever done in my life was to be born two years ahead of the Baby Boomers. That meant that when I applied to college, not that many people were applying yet, when I bought a house the big wave of home buyers would follow me and my house would be worth more. My children were two years ahead of most Boomer's kids. I went to grad school when the government wanted psychologists, so they paid me to go --very unlike today. I had enough money to begin to buy stocks in 1979. Although I made a zillions bad stock purchases I did buy MSFT, RIMM and AAPL when they were new companies and that made up of all the losses
( missed GOOG, I have not yet bought FB).
My wife is still good-looking and still a force whose ideas need to be constantly considered. My kids are healthy, employed and already own their own homes. Their kids are round and cute and curious and smiling. We all went to the beach, played golf, had cook-outs. There are always a few ripples in this perfect picture; I only hope they are enough to drive the jinx away.
Every year of the thirty years that I have worked has felt as if our social environment has made my job more difficult. There was AIDS in the 80s, and lots of divorces. There was crack and lots of bad drugs in the 90s, as well as perverted priest and rampant speculation. There have been huge changes in how we live and think which have been brought about by technology. There were the credit card and re-mortgaging binges of the 0's that were a big part of what led to the world financial collapse.
But I have never seen so many people who feel helpless and hopeless when they look to the future. This is felt most dramatically by people in their mid-20s and mid-50s. There are not enough jobs for either of those groups. The younger ones can't get started and the older ones have been tossed aside. The combination of a global workforce, the economic slow-down and technological worker replacement has hurt people not only financially, but in their sense of purpose. It is very difficult to gain any traction in your life when you feel the world doesn't need you.
I do believe that many people will realize that it is foolish to try to jump through corporate hoops and to live your life chasing after money and fame. I believe that eventually many parts of our society will establish a more worthy sense of values that will guide them towards happier more meaningful lives. But I am struck by the number of people, young and old, who are really lost and cannot function well in our new, more complex, more interconnected world. Many young people are lost to video games, Facebook, pot and pills. Many older people, who are still too young for Social Security, seem to be trying to become pathetic enough to go on disability.
Some people feel they were screwed by the system ( and they were). Others really don't know what it means to work hard and take care of themselves. Often, it's the same people.
The American Dream is that things will always be getting better. I think many of us need to decide what "better" means. Then we can figure out how to get there.
Monday, May 14, 2012
Tech is Taking us Somewhere
Despite my age, and that I sometimes have difficulty in figuring out how to operate the remote control devices of entertainment systems that are not my own, I have been fascinated by the impact of technology upon our lives. Since as recently as 2007, when the first iPhone was put on sale, there are very few aspects of our lives that have remain unchanged by technology.
How we work, where we work, how we bank, how we shop, how we date, how we teach, how we learn, how we meet people, how we communicate, what we read, what we see, what we think about, how we think, how we feel about the world, our friends, our real selves, our projected selves....... all of that and more has been altered by the use of Os and 1s being magically transmitted over cables and through the air.
This is not going to stop, so where is it all going?
One trend that will definitely continue and gain momentum, is that so much more about you will be known and much of it will be generally available. There are so many new and improving ways to explore, measure and view, what is going on with your physical self. We can see the blood and electricity flow through your brain. We can get a printout of your personal genomes. We can do CAT scams and MRIs of all of your body to see what works, what is broken what is twisted and what is missing. You can get an app that will constantly measure your heart rate, blood oxygen, blood pressure,caloric intake, caloric usage, all on your wrist. All of this can be stored in "the cloud" and can be retrieved by your physician, perhaps by anybody.
In addition there is all the information we ourselves choose to put out there about ourselves, on Facebook, Linkedin, Twitter, Tumblr,YouTube, Match, and the hundreds of other sites that we click on, shop at, comment on. At MIT they are creating devices that can almost immediately conjure up an entire profile of a person as he or she walks by you, based upon their image, and everything about them that has been placed on the web.
As with everything, there will be positive and negative aspects of all of this. But that won't matter that much because these things will, to some extent happen. What does matter is what the effects will be, both intended and unintended. This should help us be better equipped to stay healthy and prepare ourselves for our own, individual futures. We should be able to have an easier time finding people who we will enjoy getting to know and spending time.
But, at least as I feel so far, we will continue to be overwhelmed with information. We will have to find away to sort, select and evaluate what is real, true and important. We will have to learn to deal with how we feel the electronic presentation of ourselves really reflects who we are. We will have to see how all of this affects how we evaluate other people, and how we think of ourselves in relation to the world.
It will all be very different, and have much more of an impact than the changes brought about by older technologies, such as when so many people began spending their time watching TV.
In many ways the medium is still the message. But now, so much of the medium is us.
How we work, where we work, how we bank, how we shop, how we date, how we teach, how we learn, how we meet people, how we communicate, what we read, what we see, what we think about, how we think, how we feel about the world, our friends, our real selves, our projected selves....... all of that and more has been altered by the use of Os and 1s being magically transmitted over cables and through the air.
This is not going to stop, so where is it all going?
One trend that will definitely continue and gain momentum, is that so much more about you will be known and much of it will be generally available. There are so many new and improving ways to explore, measure and view, what is going on with your physical self. We can see the blood and electricity flow through your brain. We can get a printout of your personal genomes. We can do CAT scams and MRIs of all of your body to see what works, what is broken what is twisted and what is missing. You can get an app that will constantly measure your heart rate, blood oxygen, blood pressure,caloric intake, caloric usage, all on your wrist. All of this can be stored in "the cloud" and can be retrieved by your physician, perhaps by anybody.
In addition there is all the information we ourselves choose to put out there about ourselves, on Facebook, Linkedin, Twitter, Tumblr,YouTube, Match, and the hundreds of other sites that we click on, shop at, comment on. At MIT they are creating devices that can almost immediately conjure up an entire profile of a person as he or she walks by you, based upon their image, and everything about them that has been placed on the web.
As with everything, there will be positive and negative aspects of all of this. But that won't matter that much because these things will, to some extent happen. What does matter is what the effects will be, both intended and unintended. This should help us be better equipped to stay healthy and prepare ourselves for our own, individual futures. We should be able to have an easier time finding people who we will enjoy getting to know and spending time.
But, at least as I feel so far, we will continue to be overwhelmed with information. We will have to find away to sort, select and evaluate what is real, true and important. We will have to learn to deal with how we feel the electronic presentation of ourselves really reflects who we are. We will have to see how all of this affects how we evaluate other people, and how we think of ourselves in relation to the world.
It will all be very different, and have much more of an impact than the changes brought about by older technologies, such as when so many people began spending their time watching TV.
In many ways the medium is still the message. But now, so much of the medium is us.
Monday, May 07, 2012
More Tech Fallout
One thing that I see very often in my office, that our nation and our government is struggling to deal with, is how the fantastic new advances in technology is changing everyone's lives and minds. We act differently, we think differently, we relate different, and certainly every business in America works differently because of the digital changes that have happened just in the last five years. I date the latest major transformation to 2007, when the iPhone first went on sale.
For many people the new technology has made jobs easier, or even just made them possible. People can, and do work from everywhere. But so many people are being put out of work, and so many are just not necessary.
The latest to come into my office is an angry 37 year old man who has been wit the company for 11 years. Which company; the phone company. He knows, but he won't really admit, that they just don't need him any more. He is an installer and repairman for land lines. The landline business is fading as quickly as the video store rental business. The phone company could probably get by with about 1/3 of the workers they have. It is only the union that keeps hanging on.
But, the phone company, being a big corporation, is using technology to get rid of the people. They have GPS systems tracking their every move, they send the workers out with hand-held devices that report back as each task is done, each job is started, each is completed, and how quickly the worker moves from one to the next. Then they raise the expectations of what is expected in a day. Then they raise them again. Then they get on the worker for not meeting expectations.
Stress, conflict and misery.
My patient knows his time is limited and he should learn new skills and find his way in the new world. Instead his fear and uncertainty is turned into anger at the company. The company would probably do better to take him and many of his colleagues and retrain them. Teach them to deal with wireless technology. Teach them how to operate the cloud. At least give them the opportunity.
But that would involve using skills that most big corporations don't have. So, things will end badly, and more people end up in my office.
And so do their families.
For many people the new technology has made jobs easier, or even just made them possible. People can, and do work from everywhere. But so many people are being put out of work, and so many are just not necessary.
The latest to come into my office is an angry 37 year old man who has been wit the company for 11 years. Which company; the phone company. He knows, but he won't really admit, that they just don't need him any more. He is an installer and repairman for land lines. The landline business is fading as quickly as the video store rental business. The phone company could probably get by with about 1/3 of the workers they have. It is only the union that keeps hanging on.
But, the phone company, being a big corporation, is using technology to get rid of the people. They have GPS systems tracking their every move, they send the workers out with hand-held devices that report back as each task is done, each job is started, each is completed, and how quickly the worker moves from one to the next. Then they raise the expectations of what is expected in a day. Then they raise them again. Then they get on the worker for not meeting expectations.
Stress, conflict and misery.
My patient knows his time is limited and he should learn new skills and find his way in the new world. Instead his fear and uncertainty is turned into anger at the company. The company would probably do better to take him and many of his colleagues and retrain them. Teach them to deal with wireless technology. Teach them how to operate the cloud. At least give them the opportunity.
But that would involve using skills that most big corporations don't have. So, things will end badly, and more people end up in my office.
And so do their families.
Wednesday, May 02, 2012
statistics
Intro:
Last week I began to write this as a blog post. As I continued with it I thought it would be interesting to post it on a list read by other practicing psychologists. Part of this was in response to an editorial that I wrote about last week. I was curious to see if other therapists would really discuss what happens in their practices.
This is what I posted:
For no particular reason it seems to be the time to gather statistics and demographics. We Psychologists, especially those of us who still accept payments health insurance companies, have been told for years that we had better be prepared to demonstrate that what we do is effective and efficient, as well as medically necessary.
Of course, there is no agreement on how to define or measure any of those things. Over the last four years three different insurance companies devised three different ways to attempt to do this. They tried to survey either the therapists, patients or both about different ways in which the patients were functioning, suffering, changing, or just wasting time and money. Within a years time, give or take, all three gave up the effort. All of the therapists were offended, felt intruded upon, and reported that the measures were misguided and not relevant. The patients all objected to being subjected to Big Brother about confidential information, or else they couldn't understand the questions or where they came from or why they were being asked.
The insurance companies found a better, simpler way to deal with our effectiveness and efficiency: they reduced our pay.
END OF POST
I was pleased that I did my own analysis and I think I will look at the figures more closely. I did get several responses, but most of them talked about ways to do an analysis, or questions they were interested in looking at. However, and this surprised and disappointed me, no one was revealing about their own practice. No one talked about how long they see patients, or how successful they feel they are, and by what measurement.
I don't want to jump to conclusions, but it makes me wonder. About a lot of things.
Last week I began to write this as a blog post. As I continued with it I thought it would be interesting to post it on a list read by other practicing psychologists. Part of this was in response to an editorial that I wrote about last week. I was curious to see if other therapists would really discuss what happens in their practices.
This is what I posted:
For no particular reason it seems to be the time to gather statistics and demographics. We Psychologists, especially those of us who still accept payments health insurance companies, have been told for years that we had better be prepared to demonstrate that what we do is effective and efficient, as well as medically necessary.
Of course, there is no agreement on how to define or measure any of those things. Over the last four years three different insurance companies devised three different ways to attempt to do this. They tried to survey either the therapists, patients or both about different ways in which the patients were functioning, suffering, changing, or just wasting time and money. Within a years time, give or take, all three gave up the effort. All of the therapists were offended, felt intruded upon, and reported that the measures were misguided and not relevant. The patients all objected to being subjected to Big Brother about confidential information, or else they couldn't understand the questions or where they came from or why they were being asked.
The insurance companies found a better, simpler way to deal with our effectiveness and efficiency: they reduced our pay.
So,
tonight I decided to do some statistical evaluation, just to get a
reading on how I was doing as a private practice therapist after 30
years. I looked back to April of 2011 and picked out the first 50
people I saw (there were 54) that month. I do not claim this to be
hard science. I admit to nineteen flaws in my methodology, but hey, no
one gave me a grant. But I thought it would be of interest to the folks
of this division, as few people ever say in much detail what they do,
how hard they work, or how it turns out.
Of
the 50 people, a year later I am still seeing 29 ( 59%). Of those,
over half (16) of them I have already seen for over two years without
any significant break. But of those, there are only two that I still
see weekly. The others are bi-weekly (6), monthly (6), or 4x a year (2).
Of
the 21 people who terminated over the last year my rating scales of
success in treatment ( held to a standard of consistency over 25 years,
with a very high rater reliability, however the N of raters is 1.) 3 of
the 21 did not do well at all, despite my efforts and skills. 3 did
OK, and 15, in many ways accomplished what they hoped to realize from
coming to see me. Some of them really, really changed during the time
they saw me. Others,(4) I need to add, came with very specific problems
such as an isolated phobia, a problem with a grow-up child or such.,
and they just wanted to sort out that matter. Four others of the 15
came to get something specific from me, mostly relating to work or
school, such as a letter or a report that they were not dangerous, or
drug addicted, and could go back to work.
Of
the 50 people, the rating scale shows that 36 (72%) did, or are doing
well, or really well. 14 (28%)did not or are not. Of those 14, I still
have almost reasonable hope that 4 of them will still show significant
improvement. Of these 50 people, no one in the sample came for just one
session, although that happens. The shortest time in treatment was
three sessions, and that was one of the people with a specific family
problem. Everyone in the sample got treatment for something that I feel
was clearly "medically necessary." Five people (10%), less than it
feels like to me, have a diagnosis of "completely nuts," and will remain that
way.
Yes,
the rating scale is based on how I feel my patients did, with some
feed-back from them. But I believe this is fairly accurate. I can tell
that I enjoy seeing the people who are changing and doing well, and
much less so when the therapy is not working. This year I have begun to
implement use of Duncan and Miller's three question ratings, but not
with everyone.
I can also (not) tell you that I averaged $XXXX ( I wish) per hour of treatment.
I
can do more analysis and determine how long I have been seeing
everyone, and how severe their presenting problems are, and how that
correlates with their socio-economic status (not as much as I thought),
or with the success of treatment. But I'm tired and this is enough for
now.
I
hope this was of interest and perhaps inspires others of you to
evaluate your efforts. It also helps to see who you work well with and
who you don't, and see if that changes.
END OF POST
I was pleased that I did my own analysis and I think I will look at the figures more closely. I did get several responses, but most of them talked about ways to do an analysis, or questions they were interested in looking at. However, and this surprised and disappointed me, no one was revealing about their own practice. No one talked about how long they see patients, or how successful they feel they are, and by what measurement.
I don't want to jump to conclusions, but it makes me wonder. About a lot of things.
Monday, April 23, 2012
another sleaze
There is soooo much out there to try and keep track of that it gets ridiculous. The idea of keeping up with the new research in brain chemistry, physiology, cognitive therapy, fMRI studies of someone's brain in every mood and situation, of behavioral genetics, of unconscious social forces ..... all kinds of stuff comes rolling in. So often one study will contradict another one, or someone needs attention so he will hyperbolize even the slightest indication of a determining factor.
Then, this weekend, there was a series of articles in the NYT Magazine section, telling the world that depression is a complex disease of the brain, and that psychotherapy, which is often the most successful treatment for it, hardly gets mentioned.
Now the psychiatrist who wrote about the brain disease did discuss two things I agree with; first that most of the current psychiatric medications don't work for most people, and second, that the term "depression" probably covers several very different conditions, some of which really are caused by a malfunctioning brain, and others which are really reactions to terrible, stressful situations. But then he went back to treating the brain, as if it was "the mind" which it isn't, yet.
There was also an article in the Magazine about taking LSD when you're old and dying. this is stuff I have known about, and I am looking forward to .....but not yet.
Then there was the article in the Review section by Jonathan Alpert, sleaze-bag who decided that psychotherapy often goes on too long and is done that way because therapist are unskilled and just want the money. Now Mr. Alpert, who says he has an advanced degree in psychology, right there is showing what a sleaze he is. He has a MA of some kind, and under NY licensing laws he should not imply that he is a psychologist. He also has written some book about how to change your life in 28 days.
What is shocking, and harmful, is that the Times gave this guy space. Somebody must be doing someone some kind of favors.
Anyone who has read this blog knows that I am not an advocate of endless therapy. I have even written about it. But some people need it. And to imply that most psychologists do it is the kind of thing that could discourage people who need help for seeking it, for fear that a therapist will entrap them forever.
He also says that what most people need is an aggressive therapist who will tell them what to do. Clearly, this guy has not done much therapy. 80% of the people who come to see me know exactly what they should be doing. It's finding out why they don't do it that is necessary, and then finding a way around those, often self-imposed obstacles that makes therapy work. If you just need someone to tell you what to do, then send an email to Dr. Phil.
There is so much psychological garbage flowing through the Internet, it is a real shame that the Times has to add to the pile.
Then, this weekend, there was a series of articles in the NYT Magazine section, telling the world that depression is a complex disease of the brain, and that psychotherapy, which is often the most successful treatment for it, hardly gets mentioned.
Now the psychiatrist who wrote about the brain disease did discuss two things I agree with; first that most of the current psychiatric medications don't work for most people, and second, that the term "depression" probably covers several very different conditions, some of which really are caused by a malfunctioning brain, and others which are really reactions to terrible, stressful situations. But then he went back to treating the brain, as if it was "the mind" which it isn't, yet.
There was also an article in the Magazine about taking LSD when you're old and dying. this is stuff I have known about, and I am looking forward to .....but not yet.
Then there was the article in the Review section by Jonathan Alpert, sleaze-bag who decided that psychotherapy often goes on too long and is done that way because therapist are unskilled and just want the money. Now Mr. Alpert, who says he has an advanced degree in psychology, right there is showing what a sleaze he is. He has a MA of some kind, and under NY licensing laws he should not imply that he is a psychologist. He also has written some book about how to change your life in 28 days.
What is shocking, and harmful, is that the Times gave this guy space. Somebody must be doing someone some kind of favors.
Anyone who has read this blog knows that I am not an advocate of endless therapy. I have even written about it. But some people need it. And to imply that most psychologists do it is the kind of thing that could discourage people who need help for seeking it, for fear that a therapist will entrap them forever.
He also says that what most people need is an aggressive therapist who will tell them what to do. Clearly, this guy has not done much therapy. 80% of the people who come to see me know exactly what they should be doing. It's finding out why they don't do it that is necessary, and then finding a way around those, often self-imposed obstacles that makes therapy work. If you just need someone to tell you what to do, then send an email to Dr. Phil.
There is so much psychological garbage flowing through the Internet, it is a real shame that the Times has to add to the pile.
Sunday, April 15, 2012
Money comes and goes
Last
week I was messing around, trying to send a few pictures of my granddaughters to my
friends. I worked out this quick way to take them, edit them and send
them, without even using words or anything. Then I got a call from some
guy in California offering me $500 million for the whole idea. Can you
imagine the nerve, $500 million. I told him not to call again unless
he would give me at least 2X that. Now I'm working on something even
better. It only does pictures of kittens.
Nooo, that didn't really happen. What did happen was that I was in my office seeing all kinds of people with all kinds of problems. In fact, on one day last week I saw two different people whose father died, one person whose cat died, one person whose dog died and a woman whose husband was just diagnosed with cancer.
I was trying my best to do something for them using the limited powers of my skill set. I realize they are limited because Medicare, followed by other, "private" insurance companies, cut what they pay me by 5%. Medicare had been giving me raises of 3% +/- per year, but this is an election year. Two of the private companies have not raised what they pay me for 20 years!
But, I also read that the CEO of Liberty Mutual Insurance Company last year was paid $50,000,000. That's I guess because of his brilliance at cutting what everyone else gets. His board voted him that salary. Of course, he pays his board $200,000 to come to four meetings a year and vote on his salary. That is what they call a "free market."
Money comes, money goes. If you think too much about it will drive you crazy, You will end up in my office, and I will not be getting rich by seeing you.
Nooo, that didn't really happen. What did happen was that I was in my office seeing all kinds of people with all kinds of problems. In fact, on one day last week I saw two different people whose father died, one person whose cat died, one person whose dog died and a woman whose husband was just diagnosed with cancer.
I was trying my best to do something for them using the limited powers of my skill set. I realize they are limited because Medicare, followed by other, "private" insurance companies, cut what they pay me by 5%. Medicare had been giving me raises of 3% +/- per year, but this is an election year. Two of the private companies have not raised what they pay me for 20 years!
But, I also read that the CEO of Liberty Mutual Insurance Company last year was paid $50,000,000. That's I guess because of his brilliance at cutting what everyone else gets. His board voted him that salary. Of course, he pays his board $200,000 to come to four meetings a year and vote on his salary. That is what they call a "free market."
Money comes, money goes. If you think too much about it will drive you crazy, You will end up in my office, and I will not be getting rich by seeing you.
Saturday, April 07, 2012
Me and Phil
For the last hour, when I was not just watching the sun,sky and trees, I was reading the reviews of the books of Philip Roth. I guess he won another Mann-Booker Prize this year so there is more about him being written. He is quoted in the NYT today saying that he no longer reads any fiction. He said "he wised-up."
He has written 53 books now. I have read four. He is now eighty, about thirteen years older than I am. He grew up and often writes about the area about five miles from where I went to high school. Some of the streets he mentioned in many of his stories are a block away from where I lived. Mr Roth is a bit more intense than I am, but many of his themes are the same that I deal with every day I'm in my office: family, the lasting effects of parents, sex, trying to determine the right thing, trying and failing to do the right thing, feeling guilty about not doing the right thing. sex, struggling with relationships, struggling with religion over and over again, struggling aging, and struggling the crazy politics of America.
Reading Mr. Roth has always intrigued me and annoyed me. I guess because our backgrounds are similar in some ways, and what he thinks about overlaps so much with what I see, and think about. But he is soooo self-absorbed, and so pedantic that I find myself telling him to just shut up and cope.
also, the thirteen years difference puts him in a different generation. His views are shaped more by the depression, war and Holocaust than mine are. But he is so often correct,as I can see even now as a scan several of his books through the graces of Amazon and Google. I would not have this easy access to all these writings even seven years ago, and now I can read it anywhere at any time.
Given that the world works that way now, with everything immediately available, everyone immediately visible, and much too much immediate knowledge, perhaps he's right. Who needs the creations of a fiction writer when reality is constantly available, in all of it's complexity.
I guess there are still many who want to see the world in terms of good and evil, good guys and bad guys, right and wrong. That is the fiction.
He has written 53 books now. I have read four. He is now eighty, about thirteen years older than I am. He grew up and often writes about the area about five miles from where I went to high school. Some of the streets he mentioned in many of his stories are a block away from where I lived. Mr Roth is a bit more intense than I am, but many of his themes are the same that I deal with every day I'm in my office: family, the lasting effects of parents, sex, trying to determine the right thing, trying and failing to do the right thing, feeling guilty about not doing the right thing. sex, struggling with relationships, struggling with religion over and over again, struggling aging, and struggling the crazy politics of America.
Reading Mr. Roth has always intrigued me and annoyed me. I guess because our backgrounds are similar in some ways, and what he thinks about overlaps so much with what I see, and think about. But he is soooo self-absorbed, and so pedantic that I find myself telling him to just shut up and cope.
also, the thirteen years difference puts him in a different generation. His views are shaped more by the depression, war and Holocaust than mine are. But he is so often correct,as I can see even now as a scan several of his books through the graces of Amazon and Google. I would not have this easy access to all these writings even seven years ago, and now I can read it anywhere at any time.
Given that the world works that way now, with everything immediately available, everyone immediately visible, and much too much immediate knowledge, perhaps he's right. Who needs the creations of a fiction writer when reality is constantly available, in all of it's complexity.
I guess there are still many who want to see the world in terms of good and evil, good guys and bad guys, right and wrong. That is the fiction.
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