For psychiatrists who practice dance therapy: dealing with falls

[jakeislove]

One has a moral, ethical, and legal obligation to provide services that are based on what research literature supports as most effective and efficient. That's what being a "mental health professional" means. Its what differentiates you from my grandma (grandmas are always therapeutic). Or having coffee with a "life coach." People who are not mental health professionals have no such obligations, and thus can use whatever maybe therapeutic as a first line treatment. We do not have that luxury.

Is it at all possible that we should be developing research methods better suited to study the efficacy of alternate therapies? We may lack the ability to measure things traditionally written off as placebo effect.

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[vistaril]

One has a moral, ethical, and legal obligation to provide services that are based on what research literature supports as most effective and efficient.

says who? where is that written? I know you feel that way, but don't act like it is a natural law

 

[wolfvgang22]

One has a moral, ethical, and legal obligation to provide services that are based on what research literature supports as most effective and efficient. That's what being a "mental health professional" means. Its what differentiates you from my grandma (grandmas are always therapeutic). Or having coffee with a "life coach." People who are not mental health professionals have no such obligations, and thus can use whatever maybe therapeutic as a first line treatment. We do not have that luxury.

I agree with you. I've never said that dance or ski or coffee or grandma therapy should be offered as a first line therapy for anything. Not once. I assume you are making a general statement.

I maintain that there is no problem if I want to offer a service such as Dance Therapy as a board certified psychiatrist if:
1.) I get informed consent from the patient,
2.) It is not used in lieu of evidence based practice standards,
3.) No one is being harmed
4.) No laws or professional guidelines are being broken, and
5.) Profit
I don't think there is any American Psychiatric Association guideline specifically prohibiting dance therapy as an adjunct therapy. If there is, feel free to post a link.

 

[slappy]

Is it at all possible that we should be developing research methods better suited to study the efficacy of alternate therapies? We may lack the ability to measure things traditionally written off as placebo effect.

The bigger difficulty is standardizing the treatment.

 

[slappy]

I don't think there is any American Psychiatric Association guideline specifically prohibiting dance therapy as an adjunct therapy.

Creative arts therapy has existed in psychiatry for as long as, say, existential therapy has existed in psychiatry. Doubt any organization would be callous enough to outlaw it outright.

Edited to add: Those who believe nothing in psychiatry that hadn't been rigorously studied in research settings could work effectively and efficiently for a patient are just wearing blinders. All that said, I still maintain that the OP is trolling.

 

[jakeislove]

The bigger difficulty is standardizing the treatment.

I'm not saying it works but.... if IM people can memorize/regurgitate guidelines (and come off looking smart) Psychiatrists could remember what dance step, puppy color, or thing Grandma is supposed to say for depression.

 

[slappy]

I'm not saying it works but.... if IM people can memorize/regurgitate guidelines (and come off looking smart) Psychiatrists could remember what dance step, puppy color, or thing Grandma is supposed to say for depression.

It's possible. But when we have no preliminary data, how do we know that the subtle differences between therapists in their dance movements or something as abstract as "grace" (for instance) are not confounding the results?

 

[erg923]

says who? where is that written? I know you feel that way, but don't act like it is a natural law

Vistaril, don't be such a smuck.

I'll take at the moral part if you want but your obligation to practice evidence based pstchiarty when you can takes
care of the rest.

 

[erg923]

I agree with you. I've never said that dance or ski or coffee or grandma therapy should be offered as a first line therapy for anything. Not once. I assume you are making a general statement.

I maintain that there is no problem if I want to offer a service such as Dance Therapy as a board certified psychiatrist if:
1.) I get informed consent from the patient,
2.) It is not used in lieu of evidence based practice standards,
3.) No one is being harmed
4.) No laws or professional guidelines are being broken, and
5.) Profit
I don't think there is any American Psychiatric Association guideline specifically prohibiting dance therapy as an adjunct therapy. If there is, feel free to post a link.

Lots of things could be beneficial. We don't really know if this is true or not for "dance therapy." Hasn't been studied. Seems like it would be though. But again, we need to be careful about doing seemingly common sensical leaps of faith in this work. Lots of things that sem like good ideas turn out to be duds...or worse. See this article. http://dradamvolungis.files.wordpre...reatments-that-cause-harm-lilienfeld-2007.pdf

Again, the obvious objection was to the way it was being discussed and implemented by the OP. Sounded like a cult member, as opposed to a scientificically oriented or evidence-based mental health clinician. Not good.

 

[vistaril]

Vistaril, don't be such a smuck.

I'll take at the moral part if you want but your obligation to practice evidence based pstchiarty when you can takes
care of the rest.

not trying to be a smuck and a few other posters raised the same questions about where that came from. Now I see you've added a 'when you can' qualifier, which does make a bit of difference.....but there are still some grey areas.

 

[smalltownpsych]

My objection to making everything-therapy is that it diminishes the credibility of what we do that is different from what anyone else can provide. These activities are therapeutic for a variety of reasons and as part of my treatment plan, I almost always strategize with patient on how to increase their engagement in pleasurable activities. Basically, talk-therapy works and it is difficult enough for us to promote that concept alone and it doesn't help when we get too new-agey!

 

[novopsych]

This thread has had some thoughtful responses and also some displays of bigotry toward dance therapy.

Since I began practicing dance therapy, I have faced bigotry.

I can only surmise where these attitudes come from. The dance has been used for therapeutic purposes for an untold number of thousands of years. And for thousands of years, people have tried to suppress the dance. My very own parents who married in a Southern Baptist chapel were not allowed to dance at their own wedding reception. I attended a public high school in which during school dances our vice principal would walk around and tell us to leave room for the holy spirit. Footloose basically confirms for us that we have a problem with the dance in the Western world.

Part of the Western world’s opposition to dancing, I believe, stems from the so-called Dancing Plague of 1518. In fact, early on in my practice I doubted myself because of what I knew about that plague. I had a bipolar woman in her 20s as a patient who, after our sessions ended, continued dancing while I was setting up her next appointment. I encouraged her to stop, as the dance ends when therapy ends. She wouldn’t. She didn’t seem able to. It wasn’t a specific dance routine, but just a general type of movement as if she had an earworm. After the frame of actual dance therapy had ended, she continued with recreational dance moves, saying things like, “Backing it up, backing it up,” while clapping her hands as she moved around (in a backward, scooting motion). She would yell, “Whoo! Whoo!”

She told me that she danced more and more like this at home and that her younger siblings had started dancing with her. Knowing how these things have spread in the past, I became concerned.

It wasn’t until my mentor pointed out the obvious flaw in my thinking that I realized what was going on. My patient wasn’t dancing at all. The dance is not random movements you make compulsively to an earworm. The dance is love channeled through discipline of the body. I looked back at the events of 1518 and realized there never truly was a dancing plague. Those people weren’t dancing. No one can be entirely sure what they were doing. But dancers don’t die from the dance. Dancers who dance are living to the full. Those people in 1518 obviously died of something, but it wasn’t the dance. And I believe the dance has been unfairly maligned ever since in our collective Western conscience to the point my parents couldn’t dance at their own wedding reception.

Perhaps my bipolar patient was afflicted with the beginnings of whatever affected those poor souls in 1518, but it was one of those 10% of cases where it became necessary to use medication to treat her bipolar disorder. This is why I love my job. I get to help people through a full arsenal of means, whether it’s the dance or an anticonvulsant. I cannot, however, help a patient who refuses to help herself. This is why I try to attract a vibrant clientele.

I would challenge any of those who questions my motives or actions to question how unwittingly they are affected by cultural bias against the dance. You need to recognize that what happened in 1518 is not what happens on the stages of Broadway today, dance classes across the world, and is not what i teach in my private practice.

 

[erg923]

I am sorry we have hurt "the dances" feelings. However, nowhere in that rambling post did you even attempt to address the very legitimate concerns/points that were made by posters. Perhaps you would like to respond to those concerns? See posts #36, 49, and 60, for example...

 

[smalltownpsych]

I love dance, but I don't love the idea of dance therapy as a treatment for mental illness. Is dance good for people? Of course. I don't think anyone here is objecting to dance itself so I think your assertion of bias against dance is off base. I have the same objections to art, music, equine, pets, aromas, etc. I also don't think anyone disagrees with the concept that dance can be therapeutic. I will continue to make fun of all fringe therapies because they devalue what I do and what I do saves lives so I feel very strongly about it!

 

[hamstergang]

Part of the Western world’s opposition to dancing, I believe, stems from the so-called Dancing Plague of 1518.

Is anyone still doubting this is a (poor) joke?

 

[smalltownpsych]

Did I get played? lol I would only hope so. Unfortunately, I have run into too many people who advocate these "therapies" so I just assumed it was one more crackpot.

 

[MacDonaldTriad]

There was this couple going to a Baptist minister for premarital counseling. The minister told that that s*x before marriage was a no-no. Dancing was a no-no because it could lead to s*x. They asked about after marriage. The minister said that after marriage, the more the better, and with variety. So the couple started asking about positions. Laying down, yes; sitting, yes, side by side, yes. Then they asked about standing, the minister shouted back "NO, it might lead to dancing!"

 

[novopsych]

Is anyone still doubting this is a (poor) joke?

The dance is my life, so I take it personally when historians attribute the dance to the death of hundreds of Europeans. And it's no wonder the dance is now so maligned among doctors. It was doctors who advised authorities to keep the "dancers" "dancing" thinking it was the only cure, which is obviously a ridiculous notion. This happened only 500 years ago, so of course the field of medicine is still influenced by these events.

If you think it's funny that hundreds of Europeans died under doctors' orders to keep "dancing" then you have a strange sense of humor.

 

[erg923]

Dude. What. The . ****. Lol

The dance is my life, so I take it personally when historians attribute the dance to the death of hundreds of Europeans. And it's no wonder the dance is now so maligned among doctors. It was doctors who advised authorities to keep the "dancers" "dancing" thinking it was the only cure, which is obviously a ridiculous notion. This happened only 500 years ago, so of course the field of medicine is still influenced by these events.

If you think it's funny that hundreds of Europeans died under doctors' orders to keep "dancing" then you have a strange sense of humor.

 

[erg923]

It may be an important to note that the fam and I are off to the Parish picnic. There will fellowship, gambling (for Jesus), drinking, AND dancing. Good times will had by all.

 

[michaelrack]

There is only one way to settle this argument:

 

[smalltownpsych]

The dance is my life, so I take it personally when historians attribute the dance to the death of hundreds of Europeans. And it's no wonder the dance is now so maligned among doctors. It was doctors who advised authorities to keep the "dancers" "dancing" thinking it was the only cure, which is obviously a ridiculous notion. This happened only 500 years ago, so of course the field of medicine is still influenced by these events.

If you think it's funny that hundreds of Europeans died under doctors' orders to keep "dancing" then you have a strange sense of humor.

Isn't there a Monty Python sketch about how funny the Inquisition is? I think most on this site have a strange sense of humor, I just wish you had let us in on the joke sooner!

 

[Indodo]

HAHAHAHAHA
This actually turned into a serious conversation?

 

[novopsych]

HAHAHAHAHA
This actually turned into a serious conversation?

Actually, it didn't. I'm still curious to find out how other psychiatrists who practice dance therapy deal with falls, especially if they have great respect for the frame, as I do. This was a thread for other psychiatrists who practice dance therapy. The fact that it's caused so much rubbernecking by those who mock what they don't understand and who themselves don't practice dance therapy shows 1) that the dance is a true life force that draws even non-dancers in 2) that people are afraid of things they don't understand and use humor as a defense mechanism.

I will acknowledge that several posters, particularly Ceke2002, provided some great insights.

 

[xlithiumx]

Actually, it didn't. I'm still curious to find out how other psychiatrists who practice dance therapy deal with falls, especially if they have great respect for the frame, as I do. This was a thread for other psychiatrists who practice dance therapy. The fact that it's caused so much rubbernecking by those who mock what they don't understand and who themselves don't practice dance therapy shows 1) that the dance is a true life force that draws even non-dancers in 2) that people are afraid of things they don't understand and use humor as a defense mechanism.

I will acknowledge that several posters, particularly Ceke2002, provided some great insights.

3) You are being a bad doctor when your patient is seriously injured in your presence and you ignore her.

I'm going to go with #3.

 

[Ceke2002]

I will acknowledge that several posters, particularly Ceke2002, provided some great insights.

Thank you, but I'm not a medical practitioner so I obviously can't comment on the efficacy of treatment for a broad cross section of patients, and what you did, leaving an elderly lady lying on the floor with a broken hip whilst you danced off in a corner somewhere quite frankly astounds me. From a dancer's point of view, yes I did try and give you some ideas as to how you could check on your patients whilst still being engaged in the dance, because you seem hell bent on doing so anyway, but if you really are a Psychiatrist then you have a duty to first do no harm. At no point should you be putting your own desire to dance above the welfare of a patient, just because it suits your agenda to do so.

And by the way, 1518? Really? You don't know that the so called 'dancing plague' of 1518 was most likely attributable to Sydenham's chorea, also knows as St Vitus Dance, and isn't so much 'dancing' as it is uncontrollable rapid jerking of limbs. Ooh, hey, my Psychiatrist had to lower the dosage of my medication recently because I was experiencing Akathisia, maybe all that twitching I was doing was actually a form of dance and he's just being historically suppressive.

It's nut job extremists like you who give complementary therapies in Psychiatry a bad name.

 

[Ceke2002]

Did I get played? lol I would only hope so. Unfortunately, I have run into too many people who advocate these "therapies" so I just assumed it was one more crackpot.

Unfortunately I've encountered the same crackpots as a patient, and they've spoken just the way Novopysch is, so I'm finding it hard to not see this as being a serious post. Some of them really are *that* earnest.

 

[Ceke2002]

Oh dear Lady and Lord I wish my Psychiatrist was on this forum so he could school your ignorant, obsessive arse.

Edited to add: You seem to be extrapolating a lot from your own personal experiences and biases and then placing those same experiences and biases onto others who happen to disagree with you. Not everyone grew up with this ingrained idea that to dance was somehow forbidden or suppressed, or that dancing was inherently 'evil' or 'wrong' owing to historical and/or religious bias. My Mother's family were poor Presbyterian. An evening's entertainment for them often consisted of an old radio and dancing in the lounge room. I heard many a raucous story growing up of light shades being accidentally smashed when my Uncle would attempt to flip one of my Aunties over his head, or throw her in the air during a feverish Jitterbug. My Mum and her sisters would save up for weeks sometimes just to go out to the local Dance Halls and Jive Clubs, sewing their dresses out of scraps of old clothes or material. My Dad was raised a strict Roman Catholic in the Marian Tradition. His Father just happened to be a well known band leader in South Australia, so he spent much of his childhood and teenage years almost growing up in Jazz and Dance Halls, among musicians and being taught how to dance from an early age - and boy could he cut a rug like nobodies business. I can still remember my Mum, Dad, and Grandma, after I'd come along, having Friday night dance nights, watching my Dad take turns jiving or waltzing with my Mum and Grandma whilst I jumped up and down with glee in a two year old's attempt at dancing. By the time I was three I knew several basic 50's dances and dance steps. We didn't just go out to dinner, we went to dinner dances where I learnt how to Foxtrot and Waltz. My Grandma loved Bush Dancing, so I learnt that too. I've trained in Classical Ballet, Jazz Ballet, Rhythmic Gymnastics, Calisthenics, all aspects of Ballroom, Contemporary, Interpretive and Freestyle Dance. In short, I grew up with dance and it has been one of the only truly stable and constant aspects of my life that has bought me countless hours of unbridled happiness. Dance is both a joy and a passion for me, and I still think you are full of sh** for placing your own obsessional and deluded sounding needs above and beyond the welfare of your patients. Shame on you, your patients deserve better!

This thread has had some thoughtful responses and also some displays of bigotry toward dance therapy.

Since I began practicing dance therapy, I have faced bigotry.

I can only surmise where these attitudes come from. The dance has been used for therapeutic purposes for an untold number of thousands of years. And for thousands of years, people have tried to suppress the dance. My very own parents who married in a Southern Baptist chapel were not allowed to dance at their own wedding reception. I attended a public high school in which during school dances our vice principal would walk around and tell us to leave room for the holy spirit. Footloose basically confirms for us that we have a problem with the dance in the Western world.

Part of the Western world’s opposition to dancing, I believe, stems from the so-called Dancing Plague of 1518. In fact, early on in my practice I doubted myself because of what I knew about that plague. I had a bipolar woman in her 20s as a patient who, after our sessions ended, continued dancing while I was setting up her next appointment. I encouraged her to stop, as the dance ends when therapy ends. She wouldn’t. She didn’t seem able to. It wasn’t a specific dance routine, but just a general type of movement as if she had an earworm. After the frame of actual dance therapy had ended, she continued with recreational dance moves, saying things like, “Backing it up, backing it up,” while clapping her hands as she moved around (in a backward, scooting motion). She would yell, “Whoo! Whoo!”

She told me that she danced more and more like this at home and that her younger siblings had started dancing with her. Knowing how these things have spread in the past, I became concerned.

It wasn’t until my mentor pointed out the obvious flaw in my thinking that I realized what was going on. My patient wasn’t dancing at all. The dance is not random movements you make compulsively to an earworm. The dance is love channeled through discipline of the body. I looked back at the events of 1518 and realized there never truly was a dancing plague. Those people weren’t dancing. No one can be entirely sure what they were doing. But dancers don’t die from the dance. Dancers who dance are living to the full. Those people in 1518 obviously died of something, but it wasn’t the dance. And I believe the dance has been unfairly maligned ever since in our collective Western conscience to the point my parents couldn’t dance at their own wedding reception.

Perhaps my bipolar patient was afflicted with the beginnings of whatever affected those poor souls in 1518, but it was one of those 10% of cases where it became necessary to use medication to treat her bipolar disorder. This is why I love my job. I get to help people through a full arsenal of means, whether it’s the dance or an anticonvulsant. I cannot, however, help a patient who refuses to help herself. This is why I try to attract a vibrant clientele.

I would challenge any of those who questions my motives or actions to question how unwittingly they are affected by cultural bias against the dance. You need to recognize that what happened in 1518 is not what happens on the stages of Broadway today, dance classes across the world, and is not what i teach in my private practice.

 

[Tizoc]

In terms of interpretive dance modalities, I think professional wrestling does a good job of knowing when to stop or continue when someone is legitimately hurt.

 

[novopsych]

3) You are being a bad doctor when your patient is seriously injured in your presence and you ignore her.

I'm going to go with #3.

I didn't ignore her. I was intensely aware of her presence. It took everything I had to stay in frame and continue the dance. When I saw her on the floor languishing, I knew she was out of dance therapy for good. Because of my decision, her last moment of therapy will never have been her dance therapist attending to her medical needs. We ended in the dance—at least I was still in the dance when we ended. I did that to respect the frame and to respect her. She should not associate me with someone attending to physical brokenness, and I also did not want to engage in a dramatization of her actual issue. This was a patient with frequent somatoform complaints. However her hip actually fractured, I'm sure it was painful. But she was never really committed to experiencing pain in a better way. One thing you need to know about my secretary who tended to her is that she's East German and has the temperament of a good EMT. I knew if there were a serious medical issue, she could find help while I maintained the frame. It's very sad that dance therapy ended this way for this particular patient, but I strongly believe that I ended it the best way possible for her given the circumstances.

What I was asking about are the more typical patients who have occasional falls and are able to right themselves. My MO has been to use social cues to help patients minimize the importance of falls, but I started considering that it could be an opportunity for some talk therapy. My tendency though is to believe it's never wise to leave the dance. I wanted to start a conversation to get other opinions on that point, but as I've seen, I'm not sure that's possible.

 

[vistaril]

the sad thing about this thread is that many of the people who are criticizing this psych have almost certainly given patients diabetes with questionable prescribing of Seroquel, Risperdal, abilify, etc for various supposed conditions but then they're going to rip this guy for trying to get patients moving/active(I mean actually doing it not uselessly documenting that you counseled on it).............c'mon now.......

 

[slappy]

I didn't ignore her. I was intensely aware of her presence. It took everything I had to stay in frame and continue the dance. When I saw her on the floor languishing, I knew she was out of dance therapy for good. Because of my decision, her last moment of therapy will never have been her dance therapist attending to her medical needs. We ended in the dance—at least I was still in the dance when we ended. I did that to respect the frame and to respect her. She should not associate me with someone attending to physical brokenness, and I also did not want to engage in a dramatization of her actual issue. This was a patient with frequent somatoform complaints. However her hip actually fractured, I'm sure it was painful. But she was never really committed to experiencing pain in a better way. One thing you need to know about my secretary who tended to her is that she's East German and has the temperament of a good EMT. I knew if there were a serious medical issue, she could find help while I maintained the frame.

Oh she has the temperament of a good EMT does she? Why didn't you mention that before? That makes everything alright now, doesn't it? She's East German too! By all means, continue to maintain your frame, and dance away!

 

[shan564]

I also like table tennis therapy and basketball therapy. I've been trying to get into golf therapy, but at the moment, I find it to exacerbate anxiety symptoms... but some Happy Gilmore swings at the driving range can be cathartic.

I've been avoiding this thread, but I finally decided to look at it because it's getting so long. I think it's obvious that the OP is joking or trolling. Nobody would be dumb enough to admit to gross malpractice in a public forum or to say that a secretary with the right temperament would be more qualified to handle a broken hip than a medical doctor. Or to say that "I danced out of the office" instead of saying something like "I called my secretary." Or one of the many other things that have been mentioned in this thread.

 

[slappy]

If I have to choose, I'd go with sitting down with the patient and watching Seinfeld. Speaking can be discouraged as with dance therapy. $300 an hour sounds reasonable?

 

[xlithiumx]

I didn't ignore her. I was intensely aware of her presence. It took everything I had to stay in frame and continue the dance. When I saw her on the floor languishing, I knew she was out of dance therapy for good. Because of my decision, her last moment of therapy will never have been her dance therapist attending to her medical needs. We ended in the dance—at least I was still in the dance when we ended. I did that to respect the frame and to respect her. She should not associate me with someone attending to physical brokenness, and I also did not want to engage in a dramatization of her actual issue. This was a patient with frequent somatoform complaints. However her hip actually fractured, I'm sure it was painful. But she was never really committed to experiencing pain in a better way. One thing you need to know about my secretary who tended to her is that she's East German and has the temperament of a good EMT. I knew if there were a serious medical issue, she could find help while I maintained the frame. It's very sad that dance therapy ended this way for this particular patient, but I strongly believe that I ended it the best way possible for her given the circumstances.

What I was asking about are the more typical patients who have occasional falls and are able to right themselves. My MO has been to use social cues to help patients minimize the importance of falls, but I started considering that it could be an opportunity for some talk therapy. My tendency though is to believe it's never wise to leave the dance. I wanted to start a conversation to get other opinions on that point, but as I've seen, I'm not sure that's possible.

You are a doctor first and a dance therapist second. Dance therapy stops when your patient has a medical emergency in your presence. If you can't understand that you are deluded, incompetent, or both. Your absurd zealotry has seriously harmed a person for whom your primary responsibility is to heal. LEARN FROM THIS!!!

 

[erg923]

What is up with you and this "frame" crap? Your patients are human. Maybe their doctor, especially their mental health physician, should act like one too? Seems pretty straightforward to the rest of us.

Obviously, your writings show the faith and zealousness of a cult member, not a mental health professional or physician of any sort. Psychiatrists and psychologists usually use this thing we call "science/research," "outcome research," and attending to patient needs (not dance needs). You have received feedback from your peers. It was not what you wanted to hear about your practice, but it was good that you heard it.

This thread should probably closed before the person ID is revealed and licensing complaint issued. Obviously, for grandma's safety, most of us probably would report this.

 

[jakeislove]

Does anyone think grandma will have Post Traumatic Dance Syndrome?

 

[smalltownpsych]

There are many psychotherapists who won't hand a patient a kleenex because of the therapeutic frame or respond to any innocuous personal questions because of the therapeutic frame. That kind of irrational perspective will get called out by adolescents (adults might feel it is stupid but are usually more socialized to be polite). The teens love to tell me stories about therapists hiding behind their notepads or "blank slate" and how they would flip things on them by intentionally trying to make them more and more uncomfortable. Developing that type of interpersonal skill is part of what adolescence is all about and rigid thinking crackpot therapists are just grist for their mill!

 

[digitlnoize]

You are a doctor first and a dance therapist second. Dance therapy stops when your patient has a medical emergency in your presence. If you can't understand that you are deluded, incompetent, or both. Your absurd zealotry has seriously harmed a person for whom your primary responsibility is to heal. LEARN FROM THIS!!!

I go away for a few days and all he breaks loose!!! Is this a joke?!?

I remember seeing a study a while back that dance was shown to be correlated with a decreased chance of developing dementia...but I don't think that transfers to everything else.

Agree with pretty much everyone here. You can't ignore a patient with a medical emergency. When old people fall, the world stops. Help the old lady, regardless of your "frame." It's just common human decency.

This can't be real.

 

[erg923]

Would anyone care to discuss "frame" or whatever the hell? My limited understanding is that it is a dynamic/analytic relic that helped with being a "blank slate" (promoting transference, etc.) and helped to maintain professional boundaries? Maybe? However, my understanding from a historical perspective is that Dr. Freud was actually a warm, caring and rather chatty fellow with his patients. So, again what is this frame thing all about and who really developed this rigidity? What are the benefits to such rigidity in modern practice? Further, how, or rather why, is this such a fundamental element (supposedly) of "dance therapy?"

For some background here, I attended rather research-focused clinical psychology Ph.D., and frankly, Freud and other pure forms of analytic practice were mentioned minimally and begrudgingly. We did learn some short term dynamic therapies and concepts, as well as attachment and object relations, but frankly, my current practice setting (primary care psych in the VA) isn't really the place for that stuff.

Perhaps this should be broken into another thread,?

 

[jakeislove]

It's easy to imagine a bored patient making up responses and amusing themselves to see the doctor break character.

 

[vistaril]

Nobody would be dumb enough to admit to gross malpractice in a public forum or to say that a secretary with the right temperament would be more qualified to handle a broken hip than a medical doctor. .

well what you as a psychiatry resident do that the secretary wouldn't when an old person falls and breaks their hip? I'd say they have the same qualifications for that....

That said, I do agree that the emphasis on 'maintaining the frame' when an elderly person falls is a bit ridiculous. What you do in that situation is the decent human thing to do- go check on the person, and see if they need real medical assistance called. Which is the same thing as the secretary would/should do if she witnessed the fall too.

 

[michaelrack]

If I have to choose, I'd go with sitting down with the patient and watching Seinfeld. Speaking can be discouraged as with dance therapy. $300 an hour sounds reasonable?

I would combine dance therapy with watching Seinfeld

 

[hamstergang]

well what you as a psychiatry resident do that the secretary wouldn't when an old person falls and breaks their hip?

Oh, you can make that diagnosis while dancing and ignoring the patient?

What you as a doctor are qualified to do that the secretary isn't is evaluate the patient to determine what the best next step is -- rest, ambulance, AED, etc. Plus, the story in the OP involves wasting time before getting an ambulance due to not checking on the patient herself immediately. That matters, too.

 

[vistaril]

Oh, you can make that diagnosis while dancing and ignoring the patient?

What you as a doctor are qualified to do that the secretary isn't is evaluate the patient to determine what the best next step is -- rest, ambulance, AED, etc. Plus, the story in the OP involves wasting time before getting an ambulance due to not checking on the patient herself immediately. That matters, too.

and yet somehow when old people fall down in their homes their family members make these some decisions(ie whether to call the ambulance or not).....using the same basic common sense guidelines that a psychiatrist would.

Like I said before, I'm not disagreeing that ignoring an old pt who has fallen to 'maintain the frame' is dumb and innapropriate. But it's not any more dumb and innapropriate than if a msw were performing dance therapy and the same thing happened.

We don't have any special medical skills that would be useful in this situation. What we do have, and where I disagree with the OP, is the ability to do the common sense and dignified thing.

 

[Leo Aquarius]

I just started my patients on hand stand therapy. Basically when patients enter the office, they know to get on the floor and thrust their legs in the air over their heads in an attempt to do a hand stand. About 4 out of 5 times they keep trying, usually against the office wall. It's an incredible transformation. Once they get that hand stand right, a wave of delight overcomes them that their HAM-D ratings change drastically for that session. They can't believe it. Hand stand therapy should be right up there with dance therapy. I mean, the art of hand stands is so aesthetic. In fact, it reminds me of the way smoke emanates from a cigarette.

 

[SXMMD]

Wow

 

[hamstergang]

and yet somehow when old people fall down in their homes their family members make these some decisions(ie whether to call the ambulance or not).....using the same basic common sense guidelines that a psychiatrist would.

Like I said before, I'm not disagreeing that ignoring an old pt who has fallen to 'maintain the frame' is dumb and innapropriate. But it's not any more dumb and innapropriate than if a msw were performing dance therapy and the same thing happened.

We don't have any special medical skills that would be useful in this situation. What we do have, and where I disagree with the OP, is the ability to do the common sense and dignified thing.

So it sounds like you do actually think you can diagnose a broken hip from across the room. When elderly people fall, it is sometimes due to cardiac events, and also sometimes from strokes, seizures, hypotension, etc.

Of course elderly people have falls around family members and MSWs and survive, but that doesn't say anything about if their survival would be better with falls around doctors, so I'm seeing a logical disconnect between what you're saying and what you're concluding.

 

[xlithiumx]

Would anyone care to discuss "frame" or whatever the hell?

The treatment "frame" basically refers to the "ground rules" of the treatment relationship. All types of therapeutic interactions have a "frame." Even crappy "med check" psychiatry practice has a treatment frame. In that case, it's typically "tell me about symptoms, and not about your life."

 

[vistaril]

So it sounds like you do actually think you can diagnose a broken hip from across the room. When elderly people fall, it is sometimes due to cardiac events, and also sometimes from strokes, seizures, hypotension, etc.

Of course elderly people have falls around family members and MSWs and survive, but that doesn't say anything about if their survival would be better with falls around doctors, so I'm seeing a logical disconnect between what you're saying and what you're concluding.

no, I can't diagnose a broken hip from across the room. I'm a psychiatrist. That's about about as far removed as diagnosing broken hips as you are going to get.