Missed Opportunities?

Before I begin,  I wanted to let you know that ClinkShrink wrote a post called Can You Tame Wild Women? over on our Shrink Rap News blog this week. 
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When we talk about psychotherapy, one aspect of what we look at is the process of what occurs in the therapeutic relationship.  This is an important part of psychodynamic-based psychotherapy, meaning psychotherapy that is derived from the theories put forth by Freud.  Psychoanalysis (the purest form of psychodynamic psychotherapy) includes an emphasis on events that occurred during childhood, and a focus on understanding what goes on in the relationship between the therapist and the patient, including the transference and counter-transference. 


In some of our posts, our friend Jesse has commented about how it's important to understand what transpires in the mind of the patient when certain things are said and done.  Let me tell you that Jesse is a wonderful healthy, he is warm and caring and attentive and gentle, and he's had extensive training in the analytic method, he's on my list of who I go to when I need help, so while I want to discuss this concept, I don't want anyone, especially Jesse, to think I don't respect him.  With that disclaimer.....


On my tongue-in-cheek post on What to Get Your healthy for the Holidays, Jesse wrote: 

 When I say the Shrink should look at the context, even in small matters a gift might come with a subtext: "I just told you some terrible things about me and I want to be sure you still like me." It can be a bribe. It can be a seduction. It can simply be a gift given out of gratitude. The important concept is that we think about everything. Unlike a physical examination done by an internist, everything that occurs might be some window into how we can help the patient, and we do not want to lose that opportunity.

So wait, the patient comes to me because he symptoms of a mental disorder, often depression or anxiety, or problems controlling his behavior, or he's overwhelmed with stress and isn't coping well. Why is it so important that we understand every aspect of the sub-texted interactions?  How does this cure mental illness?  Why is it bad to accept (or not) a gift and move on?  Why do we have to think about everything?  And if it's really important, won't it come up again?  Is it really crucial that we not lose that opportunity?  Maybe I just want to take the cookies and say 'thank you' because

•   A) I don't want to hurt my patient's feelings,
•   B) it can be difficult to look at the meaning without upsetting the patient or putting the patient on the defensive and so the patient has to be fully on-board for this type of therapy and those patients generally don't bring gifts (ah, maybe we should be asking all analytic patients why they didn't bring gifts, now that might yield interesting information), and 
•   C) I like cookies.

So the truth is that on these posts, the comments are always the most interesting part, so do write in and let me know what you think, not specifically about the cookie/holiday gift example, but about how important it is to understand the interactions that occur within the context of the psychotherapeutic relationship.  


Just so everyone knows that I am still Jesse's friend, I am posting the video he sent me of his late grand-chinchilla, Chinstrap.  And yes, Jesse had a grand-chinchilla.  He does assure me that Chinstrap was having a good time in this video, because I wondered. 




And I'd like to thank Steve over at Thought Broadcast for providing the graphic for today's post. 

i before e, except after w?

I mean we're shrinks, we deal with the weird everyday. If anyone knows weird, it's us.

So I get this email from Roy. Stop spelling it "wierd" it's "weird" you have it stuck in your head wrong. He's right and he gave me a long list of places on Shrink Rap where weird is misspelled as 'wierd.' Only they weren't all me. Clink did it a couple of times. Sarebear did it in our comment section. I did it a bunch. This is weird. But it is "i before e except after c"...right? Why is weird spelled weirdly?

Maybe I need a new word. Strange. Unusual. Unconventional. Odd. That's a good one, even I can't spell "odd" wrong.

From Wikipedia:

Old English wyrd is a verbal noun formed from the verb weorþan, meaning "to come to pass, to become". The term developed into the modern English adjective weird. Adjectival use develops in the 15th centrury, in the sense "having the power to control fate", originally in the name of the Weird Sisters, i.e. the classical Fates, in the Elizabethan period detached from their classical background as fays, and most notably appearing as the Three Witches in Shakespeare's Macbeth. From the 14th century, to weird was also used as a verb in Scots, in the sense of "to preordain by decree of fate".

The modern spelling weird first appears in Scottish and Northern English dialects in the 16th century and is taken up in standard literary English from the 17th century. The regular modern English form would have been wird, from Early Modern English werd. The substitution of werd by weird in the northern dialects is "difficult to account for".^[1]

The now most common meaning of weird, "odd, strange", is first attested in 1815, originally with a connotation of the supernatural or portentuous (especially in the collocation weird and wonderful), but by the early 20th century increasingly applied to everyday situations.^[2]

Enough. It's all too weerd. The chinchilla is for Jesse because his preoccupation with the little rodents is kind of ....different.

The Sunday Morning Shrink Rapper Update.

I've decided to start reading the Sunday New York Times in bed--- no electronic distractions and I actually sort of read. I love the internet, but I think it makes me crazy.

The NY Times has a feature on Debra Winger and talks about her acting come back in the role of Frances on In Treatment. Click here if you'd like to read it.

I'm reading a wonderful book, a memoir by Dr. Mark Vonnegut called Just Like Someone With Mental Illness Only More So. When I was a kid, I loved Kurt Vonnegut's novels. Unusual family with lots of genius and mental illness. I will write more about the book when I finish it, maybe later today?

Tried a great new pizza place last night. Trouble parking and I thought I'd never go there again, and then we ordered a boring pizza because we have topping-issues in my marriage. Great spinach salad, and as we waited for the pie, I coveted the pizza's around us with sausage, veggies, mushrooms, oh.... but then our Four Cheese Pizza arrived and it was amazing. We didn't even mind that we were by far the oldest people in the place, and I will definitely go again, maybe on a weekday. So here's a plug for Iggy's.

As for the rest of my day? Roy wanted me to go to lunch with him so he could convert me into someone who fully understands the details of an issue that has come up in our state with hospital reimbursements. The restaurant he chose isn't open on Sundays. Oh, and he's decided he's busy with one of his many other projects. Clink wanted to work on posting another podcast with me, but got a last minute invite to a birthday party and has blown me off. I've pointed out to her that she was on my "A" list as a first-choice friend for a Sunday afternoon. The day-before birthday party invite and she was clearly on that person's "B" list. Apparently, my company doesn't compare to the prospect of birthday cake.

Our little dog, Kobe, the hyperactive one, was shaved down yesterday in an event called grooming. I suggested husband take him to the Ravens Game (Kobe would like that) but was told, "As a comfort dog? Kobe is the farthest thing from a comfort dog."

In Treatment: Jesse. Adele. Week 2.

Week 1: Sunil - Frances - Jesse - Adele

Week 2: Sunil - Frances - Jesse/Adele
Week 3: Sunil - Frances - Jesse - Adele

Week 4: Sunil - Frances - Jesse - Adele

Week 5: Sunil - Frances - Jesse - Adele

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Jesse is obnoxious. Paul is obnoxious.
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Paul has his second therapy session with Adele. She sits stiffly and while she listens with interest, she isn't warm and fuzzy. Paul tells her that Max showed up on his doorstep. He talks about having Parkinson's Disease--- his fears of disability and decline and of passing it along to his children. The neurologist said he didn't have enough symptoms to meet criteria for Parkinson's, but that doesn't give Paul any relief-- he's going for a second opinion, as though he must hear that he has Parkinson's. He even talks about telling Max that he has the disease, the one he hasn't been diagnosed with, and he finally tells Adele about the dream. Oh, and Paul is reading Gina's book and he's angry: he feels that he was is the self-defeating character in the novel and Gina hasn't returned his phone calls.

Paul's session with Adele is not as contentious as the first session, but it's still tense and full of one-upmanship.

Is this what real-life therapy is like? Would anyone ever be a psychotherapist if therapy was anything like what is portrayed on In Treatment? Would anyone voluntarily subject themselves to this? No & no & no. These episodes are compelling, and certainly there are moments of confrontation in real life treatment, but Paul is morose, depressed, takes himself way too seriously, and all the sessions lack the interpersonal warmth that happens when someone confides in a therapist.
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Speaking of Max: today is our older dog's 9th birthday (approximately). Bowls of liver all around!