"I don't need therapy"

[F0nzie]

Clinical scenario:

Pt takes up all of your time to vent and does not want to leave your office. Pt states "I don't need therapy. Everything is fine". You can barely get a word in because the patient will not stop talking. You attempt to highlight their need to take up the entire time talking to how they may benefit from seeing a therapist more frequently. You highlight this over and over again in subsequent sessions and it never registers. You look at the clock and an hour has gone by. You are now running late even though you have already stated several times that there is no more time left. You stand up and walk towards the door. The pt is not picking up on any social cues and continues to sit firmly in their chair talking like nothing just happened. You break the patient's line of sight by leaving the office. You feel like a rude son of a b*tch. This triggers the pt to finally get up and follow you into the hallway. You desperately try to get front staff to redirect the patient. (Does it really have to end this way?) The pt then seamlessly continues the conversation with front staff without the context anything that was said to you over the past hour...

What the hell is this?

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[slappy]

Sounds like mania to me.

 

[splik]

whether the pt needs therapy is one thing but they don't sound like a good candidate for psychotherapy

though the patient sounds quite narcissistic and aggressive. talking at you for an hour is an act of hostility.

 

[nitemagi]

Pressured speech? Do they pause when you try to speak?
Narcissism (agree it's a possibility)?
Autism Spectrum?
Psychomotor agitation?
CC?
What are they talking about? Occasionally I will have people who will not relent as they try to convince me of something (sometimes unconsciously). Acknowledging the thing can defuse it.
Hard to say without more info.

 

[heyjack70]

I often find the voluminous talkers are using it as a defense.

 

[birchswing]

So, what is therapy anyway? Normally it's having a goal and working on meeting that goal using various techniques with another person.

Not wanting therapy doesn't meant not wanting therapy. It means not wanting to be dismissed by you—the person he/she sees herself as already doing therapy with. His/her goal is presumably to feel better and talking to you does that. Maybe it's not therapy by a technical definition, but it's therapeutic. Maybe it's maladaptive, but it's therapeutic.

I often find the most enlightening and satisfying conversations I have are when the other person doesn't talk—I even enjoy text messaging when the other person isn't there. Is it maladaptive to go into soliloquy in therapy? Maybe by some definitions. But you could argue paying someone to rub your muscles until they feel better isn't the right way to deal with your problems, yet it's quite socially acceptable.

It seems he/she's already getting what she wants, and there's no reason to believe they feel bad about it. You feel bad about it. Now, granted, I'm not a doctor, and I'm sure people think it's very rich I'm giving advice.

But it would be:

Separate the part out where you feel angry at him/her for making you uncomfortable. Accept that you have no reason to believe they're in discomfort from the way you end sessions--you only know for sure that's in your mind and nowhere else.

Then, talk about the issues that still remain, as if you are the therapist you want him/her to see. Maybe issues such as: Does it feel like ending our sessions is difficult? Is venting helpful?

But it may be that there is no issue to discuss in therapy. It's possible this person isn't offended at you cutting them off and continues this all day long with whoever is there--or maybe when no one is there at all. I know my negative rumination continues with or without an audience.

Could be a touch of something on the autism spectrum? Who knows. But I think most people adapt to having such people in their lives by setting limits. I'm not generally offended when people cut me off.

Therapy as a place to send a person just so that they can continue talking doesn't make as much sense as sending them to a patient friend or relative (in that the friend or relative can do the same as the therapist for free).

Edit: I just re-read the part about continuing the conversation with the front staff out of context.

That does sound odder than what I was imagining. Sounds hyperactive. Anxiety or mania or ADHD—a toss up.

 

[nitemagi]

So, what is therapy anyway? Normally it's having a goal and working on meeting that goal using various techniques with another person.

Not necessarily. Depends on the type of therapy.

There's a seeming presumption in your post that the issue is that Fonz just doesn't want the patient to talk. The issue seems moreso the monologue without paying attention to social cues to end a conversation.

There's nothing in Fonz's post about being "angry" In fact quite the opposite, where he states he feels rude for having to end the encounter.

 

[birchswing]

Not necessarily. Depends on the type of therapy.

There's a seeming presumption in your post that the issue is that Fonz just doesn't want the patient to talk. The issue seems moreso the monologue without paying attention to social cues to end a conversation.

There's nothing in Fonz's post about being "angry" In fact quite the opposite, where he states he feels rude for having to end the encounter.

The patient makes him uncomfortable. I jumped a step beyond that to say that he would be angry at the patient for making him uncomfortable. Maybe that's not true. But he's identifying the patient as the source of his stress. I was positing that it's possible the patient feels no discomfort about the situation and that he in most likelihood has nothing to feel guilty about. So if you feel guilt when there's no need to feel guilt, and you believe you feel that guilt because of the actions of another person, the emotion of anger isn't a large leap. At the least, they're not opposite emotions.

 

[Ceke2002]

Not necessarily. Depends on the type of therapy.

Yep, this.

@birchswing - Therapists aren't glorifed bartenders , but by the same token a patient who 'just wants to talk' isn't necessarily better served by sending them off to talk to a friend or relative instead. Therapists have a unique advantage in that they can be both empathetic listeners and objective observers. They are the ones that are able to guide a patient towards the understanding they need to develop, rather than just catering to their maladaptive behaviours by allowing them to talk directionless and unchecked. They are also the ones that can play the bad guy, when needed, and when appropriate, and tell patients things they may not want to hear or listen to, but which are ultimately in their best interest in terms of moving towards better emotional health - they can do this, because they're not the patient's friend, and they don't need to worry about 'If I tell Jane Doe here what I think she really needs to hear right now, then am I going to lose Jane Doe's friendship?' or 'Jane Doe is my friend, I don't want to see my friend possibly feeling hurt or upset, even if I know it's going to ultimately help her' (just to make it clear I'm obviously not talking about a therapist bullying their patients, or not taking their patient's feelings into account at all).

Of course there are therapies where there is a certain treatment goal and the goal is worked on and hopefully eventually met, and that can happen even within an individual patient's overall therapy as well, but therapy also encompasses so much more than that. Therapy isn't always just about having a goal or direction in mind and then completing said goal or direction, nor is it always about making the patient feel better. I'd say with most therapy there is the goal of moving the patient towards an increased state of wellness, or stability, but in order to achieve that goal therapy can be pretty rough sometimes. My session with my Psychiatrist yesterday was pretty intense, it was ultimately very satisfying as I did make a number of major connections and breakthroughs (and I got a lovely white board lecture about object relations theory, completely with nifty diagrams, which was kinda awesome), but I have felt very mentally drained today just because of the depth of stuff we working on. And to get to that point, where I was able to identify certain attachment patterns in adulthood and work out what was at their core, and then start plumbing the depths of my childhood to see how those attachment patterns may have formed, it took several sessions, on and off, that probably would have seemed like it was just us talking (recounting stories, anecdotes, family histories, etc). To a casual observer it might have looked like I'd just turned up to those sessions for a nice little chat, except at no point was it ever *not* therapy. That's the difference between what might look like someone 'just talking' with a trained professional, and someone turning to a friend for a bit of a deep and meaningful.

And yes there are times when I might just want to vent about something in session, but in that case I will let my Psychiatrist know that I'm just gonna take five to do that and get some stuff off my chest, rather than walk into session, sit down, and just launch a volley of words at him. In Fonzie's case I also don't necessarily think he's annoyed, or feels uncomfortable with the patient, but rather the patient's behaviours which aren't allowing him to direct the session and make the sort of observations that can lead to the sorts of realisations that can precipitate growth. Most therapists want to help their patients, and where they have a patient who through their behaviour isn't allowing that to take place, or who's pattern or style of behaviour is difficult to get a grasp on in order to know where to go with the therapy, I can imagine that can be very frustrating to someone who's job is to ultimately (hopefully) improve their patient's lives.

 

[Ceke2002]

What the hell is this?

It sounds like you might be treating my Mother...good luck with that.

(sorry I don't have anything useful to add )

 

[F0nzie]

Sounds like mania to me.

It does doesn't it. I have observed this particular dynamic more often in bipolar disorder. Their excess of speech comes and goes in waves. But what about the people who do not meet criteria for bipolar disorder, sleep like a babies at night, and who's excessive speech never goes away?

 

[F0nzie]

whether the pt needs therapy is one thing but they don't sound like a good candidate for psychotherapy

though the patient sounds quite narcissistic and aggressive. talking at you for an hour is an act of hostility.

Interesting viewpoint on the hostility. I recently I had one patient with this particular characteristic that would act all super nice to me and say how grateful he was to be my patient while he was complaining and saying a bunch of horrible things about me to the administration.

 

[heyjack70]

It does doesn't it. I have observed this particular dynamic more often in bipolar disorder. Their excess of speech comes and goes in waves. But what about the people who do not meet criteria for bipolar disorder, sleep like a babies at night, and who's excessive speech never goes away?

Decreased need for sleep is only one symptom of hypo mania/mania, and a patient could certainly be diagnosed without it.

 

[F0nzie]

Pressured speech? Do they pause when you try to speak?
Narcissism (agree it's a possibility)?
Autism Spectrum?
Psychomotor agitation?
CC?
What are they talking about? Occasionally I will have people who will not relent as they try to convince me of something (sometimes unconsciously). Acknowledging the thing can defuse it.
Hard to say without more info.

It's not pressured or agitated. Psychiatric symptoms are under control ie. Not feeling depressed, normal sleep, normal appetite, normal energy, no psychotic symptoms. It's just constant speech. Well formed thoughts and a lot to say about them. In a few individuals loneliness is a complaint. But nobody wants to be around them (I see this at the clinic where case managers are hiding from clients), I suspect in part because they won't stop talking. I see his as highly detrimental affecting all aspects of their functioning. How can they operate in society when it's just them having one big ass soliloquy?

 

[Doctor Bagel]

It does doesn't it. I have observed this particular dynamic more often in bipolar disorder. Their excess of speech comes and goes in waves. But what about the people who do not meet criteria for bipolar disorder, sleep like a babies at night, and who's excessive speech never goes away?

So admittedly I've got the House "it's not lupus" thing about bipolar disorder, which makes me maybe dismiss mania (or at least hypomania) more than I ought, but yeah, it could be, but it's not the first thing that jumps to my mind either. I agree with the talkativeness as a defense -- it gives you no room to intervene or help, which might be the enactment that's happening. It's also very entitled. I've had a few patients who've been disinterested in doing therapy but also very hard to dislodge from my office, which is curious. Too bad the patient doesn't give you any room to speak and make observations about this.

 

[OldPsychDoc]

It sounds like you might be treating my Mother...good luck with that.

(sorry I don't have anything useful to add )

Believe it or not, this was my first thought as well. (My mom, not yours...)
(Sorry, Mom...)

 

[F0nzie]

Believe it or not, this was my first thought as well. (My mom, not yours...)
(Sorry, Mom...)

I am not even sure where I am going with his thread but would be happy to hear more about your mothers. Well played Freud.

 

[PikminOC]

Interesting viewpoint on the hostility. I recently I had one patient with this particular characteristic that would act all super nice to me and say how grateful he was to be my patient while he was complaining and saying a bunch of horrible things about me to the administration.

OP patient ignored the social cues on purpose.

 

[F0nzie]

@birchswing regarding how it makes me feel: Sometimes it feels like I am being held hostage. It's a suffocating kind of feeling. I can't say anything or do anything except sit there until time is up and I just need to stand up and leave.

 

[MacDonaldTriad]

So admittedly I've got the House "it's not lupus" thing about bipolar disorder, which makes me maybe dismiss mania (or at least hypomania) more than I ought, but yeah, it could be, but it's not the first thing that jumps to my mind either.

The likelihood of bipolar disorder is inversely proportional to a patient’s insistence on having it. I encourage everyone to have a healthy skepticism of it, instead of a convenient sickly propensity to explain bad behavior with a mood disorder.

 

[wolfvgang22]

I get a lot of patients that do this sort of thing, but usually give up on talking finally when I point out they are taking time away from my next patient. Being in the VA I play on the patients patriotism to not make me late for the next veteran who deserves our support also. Sometimes this doesn't work with the last patient of the day, though. Basically, I've noticed that these patients say they don't want therapy as a defence, but get comfortable with me, and don't want to open up to another clinician. They also often don't want a female psychotherapist, but won't admit it sometimes. Many times they don't want to talk to a non-MD therapist (narcissistic). Once in a long while I just have to ask one to leave outright. I've found its actually therapeutic for a couple of patients to fire me, then fire the next two doctors, and eventually figure out he needs to allow clinicians to guide treatment. Other patients don't really listen to these kinds of patients, because they wear out their welcome with them, too.

 

[watto]

I always confront them about this, even interrupting them to get a sense of how they react when someone else is not following social cues. It's interesting to note if they are aware or unaware if what they are doing, then to discuss how this behavior can interfere with basic human communication and therefore, relationships. Then you can do some mentalization work, if needed.

If they have no clue what they are doing, it's more rote teaching what is appropriate for fluency and what is not - almost like teaching an Aspie rules of social contact.

 

[OldPsychDoc]

@birchswing regarding how it makes me feel: Sometimes it feels like I am being held hostage. It's a suffocating kind of feeling. I can't say anything or do anything except sit there until time is up and I just need to stand up and leave.

OMG--it IS my mother!

 

[F0nzie]

OMG--it IS my mother!

LOL!

 

[erg923]

Do you set an agenda and/or structure at begining of your sessions? CBT generally dictates this. It very good way to prevent sessions from winding and curving all over the places and expanding over the appointment time.

 

[nitemagi]

I agree with Erg. If I sense it's going in this direction I will drop a "I'm just mindful of the time" and attempt to redirect the conversation when there's 10-15 mins left.

 

[Doctor Bagel]

Do you set an agenda and/or structure at begining of your sessions? CBT generally dictates this. It very good way to avoid sessions from winding and curving all over the places and expanding over the appointment time.

Or simply explain the length of the appointment and end with "we're going to have to stop" shortly before you have to stop. That's how I've seen more psychodynamic types do it. I've found, though, that establishing a frame from the beginning is much easier than trying to impose one later. It's also easier when you have true control over the clinic and don't have people slotted in your clinic all over the place. Some of our clinics start to resemble primary care types of clinics which are chaotic places with very little frame and constantly running over/running behind.

 

[splik]

give him a little more credit. he would know if the patient was manic, and he has tried to let the patient know it is time to stop and the patient continues with his attack. don't feel bad about repeatedly interrupting, you will not affect the therapeutic alliance because there is none

 

[smalltownpsych]

My first thought when reading the title was "Fonzie is in denial!" Seriously though, don't confuse his talking for a need for therapy. What is his presenting problem and how does that tie into what he does to you? Call him on it. How he responds to a blunt interpretation will tell you whether it is more malignant narcissism verse autism spectrum/social difficulty. If it is the first, firm boundaries, if it is more the second, then...hmmm on second thought if it was the second, they would probably not be so resistant to talking to someone else and you probably wouldn't have so much negative countertransference.

 

[Ceke2002]

...nvm, prattling contributing naught to the topic at hand

 

[birchswing]

@birchswing regarding how it makes me feel: Sometimes it feels like I am being held hostage. It's a suffocating kind of feeling. I can't say anything or do anything except sit there until time is up and I just need to stand up and leave.

That is interesting. As far as I know it's the psychiatrist's job to set the parameters. It sounds like a loss of control. What happens if you just interject?

It's funny, BTW, how many people mention their mothers. My mother did, and probably still does, this, as well. I remember being at department stores with her when she was buying or returning things and being very embarrassed over this. She would talk to the cashier nonstop and then as soon as they were busy she would start talking to someone else in line, making conversation about the return or purchase, and she would laugh to sort of get the other person to get into the flow of the conversation. She's someone who when she's not "on" is very quiet and tends to isolate (TV and iPad). But when there's a party, she's a very "on" host and will not stop talking and laughs very loudly. I would get annoyed because as a child I would want to practice Swedish with her (she's from Sweden). She never wanted to--she was not big into being communicative with me or really anyone. She was, when not in social situations outside the family, very reserved. But at parties she would go on and on, and sometimes she would turn to me and try to get me agree with what she was saying in Swedish, "Eller hur?" ("Don't you agree?"). I would stare at her and be thinking, "Really? You now want me to talk to you? And in Swedish?" It was always in front of friends that she became very interested in me. She would talk about my accomplishments and interests, that I was otherwise unaware that she was aware of.

Anyhow, I'm jaywalking down memory lane again. Still very interesting connection to mothers.

 

[Ceke2002]

It's not pressured or agitated. Psychiatric symptoms are under control ie. Not feeling depressed, normal sleep, normal appetite, normal energy, no psychotic symptoms. It's just constant speech. Well formed thoughts and a lot to say about them.

I can be a lot like this in my sessions from time to time, usually when I've either made a breakthrough, or I'm on the cusp of making one, which for some reason translates to a session of me yapping my head off - albeit without the missed social cues of actually needing to shut up and let him get a word in edgewise at some point. For me over talking at this time is more along the lines of attempting to connect thoughts and ideas, or trying to reiterate a connection of thoughts and ideas. Is it possible your patient is over engaging in some sort of free association type thing in the hope that if she just talks and talks and talks that something will just click eventually, only right now she doesn't actually consciously know she's doing this?

 

[daru1]

Sounds like a 99215+90833

 

[F0nzie]

Sounds like a 99215+90833

That's an audit right there my friend.

 

[MySpirit]

That is interesting. As far as I know it's the psychiatrist's job to set the parameters. It sounds like a loss of control. What happens if you just interject?

It's funny, BTW, how many people mention their mothers. My mother did, and probably still does, this, as well. I remember being at department stores with her when she was buying or returning things and being very embarrassed over this. She would talk to the cashier nonstop and then as soon as they were busy she would start talking to someone else in line, making conversation about the return or purchase, and she would laugh to sort of get the other person to get into the flow of the conversation. She's someone who when she's not "on" is very quiet and tends to isolate (TV and iPad). But when there's a party, she's a very "on" host and will not stop talking and laughs very loudly. I would get annoyed because as a child I would want to practice Swedish with her (she's from Sweden). She never wanted to--she was not big into being communicative with me or really anyone. She was, when not in social situations outside the family, very reserved. But at parties she would go on and on, and sometimes she would turn to me and try to get me agree with what she was saying in Swedish, "Eller hur?" ("Don't you agree?"). I would stare at her and be thinking, "Really? You now want me to talk to you? And in Swedish?" It was always in front of friends that she became very interested in me. She would talk about my accomplishments and interests, that I was otherwise unaware that she was aware of.

Anyhow, I'm jaywalking down memory lane again. Still very interesting connection to mothers.

He did try on several occasions throughout the visit. However, the patient kept going on and on and on.

 

[Psychobabbling]

Menatalization (or lack thereof)

I was talking about this with a colleague recently regarding a patient with a strong histrionic/borderline personality type. Difficult to tease out as there is a "history" of various axis I disorders in her record. However, if this is soemthing you see on a consistent and persistent basis, hypomania/mania would seem less likely.

With my patient, it is a constant bringing of drama/chaos into the room. So I meet them with "It seems you have many things going on in your life. We can focus on them or we can focus on you.....we have only a brief amount of time today, so I am sorry to say we will have to stop this part of the conversation so that we can determine how best to help you with your symptoms...." And lately it has become "I asked you a question about X, yet you consistently take me on a journey of various problems with people in your life with little actual content. We will have to stay on topic to questions asked so that you may receive the best care."

The last statement proved most useful, as they will then stay more on topic, and if they go off "okayyyy I'm sorry, I was doing it again. You were asking me about my sleep..."

 

[MySpirit]

Menatalization (or lack thereof)

I was talking about this with a colleague recently regarding a patient with a strong histrionic/borderline personality type. Difficult to tease out as there is a "history" of various axis I disorders in her record. However, if this is soemthing you see on a consistent and persistent basis, hypomania/mania would seem less likely.

With my patient, it is a constant bringing of drama/chaos into the room. So I meet them with "It seems you have many things going on in your life. We can focus on them or we can focus on you.....we have only a brief amount of time today, so I am sorry to say we will have to stop this part of the conversation so that we can determine how best to help you with your symptoms...." And lately it has become "I asked you a question about X, yet you consistently take me on a journey of various problems with people in your life with little actual content. We will have to stay on topic to questions asked so that you may receive the best care."

The last statement proved most useful, as they will then stay more on topic, and if they go off "okayyyy I'm sorry, I was doing it again. You were asking me about my sleep..."

I am curious. Are you referring to a 15 minute medication visit or is it both a psychotherapy and meds visit.

 

[Psychobabbling]

I am curious. Are you referring to a 15 minute medication visit or is it both a psychotherapy and meds visit.

I'm referring to a community mental health clinic ran by PGY3 residents yearly with 30 min appointments for each patient

 

[keifernny2]

As a resident, I dreaded these patients. As an attending, I tell the front desk to book them for an hour next time.


Sent from my iPhone using Tapatalk

 

[Jester25]

Sounds like it could be ADHD.

Could also be ASD, or at least the autistic phenotype.

 

[Shikima]

Sounds like GAD and denial.

 

[Therapist4Chnge]

Interesting case.

I'd definitely go into the next session and establish some ground rules and boundaries. Then I'd be honest that I'm going to interject/re-direct as I feel necessary. I see these types of patients frequently, though due to frontal head injuries (in an assessment setting, not therapy). I typically set an agenda for these types of patients because they generally lack the ability to do it themselves. The somaticizers do it by design. I joke with my TBI patients that I'm their frontal lobe, though many times they don't yet have the insight in how they present and how their deficits impact their ability to function.

 

[birchswing]

Interesting case.

I'd definitely go into the next session and establish some ground rules and boundaries. Then I'd be honest that I'm going to interject/re-direct as I feel necessary. I see these types of patients frequently, though due to frontal head injuries (in an assessment setting, not therapy). I typically set an agenda for these types of patients because they generally lack the ability to do it themselves. The somaticizers do it by design. I joke with my TBI patients that I'm their frontal lobe, though many times they don't yet have the insight in how they present and how their deficits impact their ability to function.

Out of curiosity, what is a somaticizer? I am familiar with somatoform disorder, but I'm wondering if there is a broader class than that. Do you mean like a Woody Allen type personality?

 

[Therapist4Chnge]

There are ppl w diff flavors under the somataform umbrella*, in addition to patients who don't meet one specific disorder, but instead check a few of the boxes with a dash (or heaping) of axis-II.

*i don't know if things were re-organized w DSM-V bc I stick strictly w. ICD-9 (soon -10).

 

[nitemagi]

It's "somatic symptom disorder" in DSM-5. They took out the necessity of symptoms not having a medical cause (cause it's rarely provable).

Somaticizers (simplified) are those that experience stress in the form of physical symptoms.

 

[sunlioness]

My favorite is when these patients show up 20 minutes late for their 30 minute appointment and remain completely oblivious that time is an issue. Even when pointed out to them at check in. "You're a bit late. We have 10 minutes together. Do you feel this is enough time or should we reschedule?" "Oh, no. I just need to get my meds refilled." But then it's off to the races again. I always chalked it up to personality issues/narcissism/entitlement/"special snowflake" syndrome.

My personality is the complete opposite of confrontational, but I've had to start getting up and opening the door to shoo them out too. The weird thing is I've found they don't really mind.

 

[birchswing]

My favorite is when these patients show up 20 minutes late for their 30 minute appointment and remain completely oblivious that time is an issue. Even when pointed out to them at check in. "You're a bit late. We have 10 minutes together. Do you feel this is enough time or should we reschedule?" "Oh, no. I just need to get my meds refilled." But then it's off to the races again. I always chalked it up to personality issues/narcissism/entitlement/"special snowflake" syndrome.

My personality is the complete opposite of confrontational, but I've had to start getting up and opening the door to shoo them out too. The weird thing is I've found they don't really mind.

How do you diagnose a doctor who is chronically 1-2 hours behind? Since I hate waiting in the waiting room I call before I leave the house to ask how the schedule is running and they always tell me on time, and so I always show up on time, but it's always at least an hour wait. I've been places where it's even worse. Why should a patient's reason for being late be any more pathological than a doctor's? Just because you know the doctor's reason for being late and don't know the patient's doesn't mean that the patient's can be any less rationalized.

Edit: The last time I had my psychiatry appointment, I got there a few minutes early. The woman who was supposed to have been seen the 15 minute block before me hadn't been seen yet and it was already a half hour past her appointment time. We ended up talking. She was the one who should have been more upset than me--she was going to be late to pick up her daughter from daycare. She told me not to worry—that she would go as fast as possible in her appointment because she needed to go get her daughter. The people at the daycare could be saying the exact same things about her picking up her daughter late (narcissistic, special snowflake, etc.).

Edit 2: I should clarify my point. I believe that you can rationalize the psychiatrist being late. She has too many patients and each patient is given 15 minutes so that they can be fit in, but in reality many patients take longer to see than 15 minutes. So, to me, I understand that. It's rational. I dislike waiting because I am very anxious in waiting rooms, but I understand it and it doesn't seem like it's a pathological thing. So, I was saying that the same could be said of a patient who is late. It's not necessarily pathological, though it could be. It could be that they're late because they were at another doctor earlier in the day who was running late.

 

[Ceke2002]

Sometimes chronic lateness in a patient is pathological though - now chronic lateness coupled with 'well I'll take up extra time yapping my ar5e off when my Psychiatrist has clearly informed me that we don't have much time, thereby forcing our Psychiatrist to run late for all their other patients', in my opinion at least, falls under the category of 'someone smack this idiot upside the head with a clue by four' (unless of course they're not exactly running on a full tank of gas neurologically speaking in which case the clue by four should probably be applied somewhat gently), but anyway, lateness can definitely be a sign of a lot of different pathology and it should be addressed in the appropriate manner for the individual patient's case.

 

[F0nzie]

How do you diagnose a doctor who is chronically 1-2 hours behind? Since I hate waiting in the waiting room I call before I leave the house to ask how the schedule is running and they always tell me on time, and so I always show up on time, but it's always at least an hour wait. I've been places where it's even worse. Why should a patient's reason for being late be any more pathological than a doctor's? Just because you know the doctor's reason for being late and don't know the patient's doesn't mean that the patient's can be any less rationalized.

Edit: The last time I had my psychiatry appointment, I got there a few minutes early. The woman who was supposed to have been seen the 15 minute block before me hadn't been seen yet and it was already a half hour past her appointment time. We ended up talking. She was the one who should have been more upset than me--she was going to be late to pick up her daughter from daycare. She told me not to worry—that she would go as fast as possible in her appointment because she needed to go get her daughter. The people at the daycare could be saying the exact same things about her picking up her daughter late (narcissistic, special snowflake, etc.).

Edit 2: I should clarify my point. I believe that you can rationalize the psychiatrist being late. She has too many patients and each patient is given 15 minutes so that they can be fit in, but in reality many patients take longer to see than 15 minutes. So, to me, I understand that. It's rational. I dislike waiting because I am very anxious in waiting rooms, but I understand it and it doesn't seem like it's a pathological thing. So, I was saying that the same could be said of a patient who is late. It's not necessarily pathological, though it could be. It could be that they're late because they were at another doctor earlier in the day who was running late.

It's really hard not to be late with 15 minute checks. Any minor event can screw up the schedule and it is really hard to recover from unless you have a no show. You may be better off picking an early AM appt.

 

[birchswing]

It's really hard not to be late with 15 minute checks. Any minor event can screw up the schedule and it is really hard to recover from unless you have a no show. You may be better off picking an early AM appt.

That emphasizes my point. It's perfectly explainable for a psychiatrist to be late without pathologizing it. And I was saying the same could be true for patients.