Articulate Psychiatrist?

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postbacpremed87

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Is it possible to be too intellectual during analysis? I sometimes feel like Psychiatrists are portrayed as overly intellectual, well dressed, articulate (think upper east side of Manhattan, legs crossed drinking tea with sweater vest). For instance, I get one understanding from a patient during my analysis but they say no no, it really meant this. It's kind of intimidating. I know your abilities improve from PGY-1 to 4 and I know some Psychiatrists are better at some things than others.

TLDR: I feel like I am too simple minded (problem -> fix it) (concrete thinker) to do Psychiatry sometimes. I don't usually offer hyper-intellectual answers (even without the terminology). I am more of a: I really enjoyed talking to the patient and throughout the course of our conversation they really gave off the impression that they may be depressed. They met all SIG E CAPS requirements. I think they could really benefit from Celexa because of X, Y, Z. That's me vs. some heavy intellectual psychoanalytical view of why they are this way.

Is there room in Psychiatry for people like me? I'm an extremely optimistic person and can relate well with patients, but I am not articulate in the way I described above.

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First, you are not a "concrete thinker", as evident in your post. Second, there is nothing wrong with a solution focused approach, and psychoanalysis is not the only valid approach to therapy. Third, psychoanalytic psychotherapy is very fluid and subjective. Do not try to over interpret the patient's own subjective experience for them, instead sort of guide the patient along to find his or her own meaning in his or her subjective experiences and interpretation in a healthy way. Take your attending's subjective interpretations with a grain of salt. These interpretations have meaning for them, and they may be right most of the time, but it is the patient's meaning that the patient finds that matters. What you need to learn most is how to be flexible in your perspective and take what is useful and meaningful for your patient and ignore what is not.

Finally, do not get caught up in an image - that a psychoanalyst or psychiatrist must look like this or be like that. Just be you, always learning and always caring, and that will be good enough to help.
 
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Is it possible to be too intellectual during analysis? I sometimes feel like Psychiatrists are portrayed as overly intellectual, well dressed, articulate (think upper east side of Manhattan, legs crossed drinking tea with sweater vest). For instance, I get one understanding from a patient during my analysis but they say no no, it really meant this. It's kind of intimidating. I know your abilities improve from PGY-1 to 4 and I know some Psychiatrists are better at some things than others.

TLDR: I feel like I am too simple minded (problem -> fix it) (concrete thinker) to do Psychiatry sometimes. I don't usually offer hyper-intellectual answers (even without the terminology). I am more of a: I really enjoyed talking to the patient and throughout the course of our conversation they really gave off the impression that they may be depressed. They met all SIG E CAPS requirements. I think they could really benefit from Celexa because of X, Y, Z. That's me vs. some heavy intellectual psychoanalytical view of why they are this way.

Is there room in Psychiatry for people like me? I'm an extremely optimistic person and can relate well with patients, but I am not articulate in the way I described above.

I think that professional psychotherapy should feel like dancing, not fencing or classroom instruction. Also, as I think Yalom is famous for noting...what clients actually find most helpful in therapy is often not what we think it is (and is almost never some kind of elaborate, verbally-expressed, intellectually-impressive interpretation or statement on the part of the therapist). Above all, I think it's important to be authentic, respectful and collaborative and not to interpret what isn't there. From your post it sounds like you'd make a good therapist. The only other comment I would make is that it seems that--rather than being told what to do (or what the solution to their problems might be)--patients generally like to express their own goals/values/preferences and work toward them with your help and guidance as needed (and when solicited). The motivational interviewing literature fleshes out the concept pretty well.
 
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Is it possible to be too intellectual during analysis? I sometimes feel like Psychiatrists are portrayed as overly intellectual, well dressed, articulate (think upper east side of Manhattan, legs crossed drinking tea with sweater vest). For instance, I get one understanding from a patient during my analysis but they say no no, it really meant this. It's kind of intimidating. I know your abilities improve from PGY-1 to 4 and I know some Psychiatrists are better at some things than others.

TLDR: I feel like I am too simple minded (problem -> fix it) (concrete thinker) to do Psychiatry sometimes. I don't usually offer hyper-intellectual answers (even without the terminology). I am more of a: I really enjoyed talking to the patient and throughout the course of our conversation they really gave off the impression that they may be depressed. They met all SIG E CAPS requirements. I think they could really benefit from Celexa because of X, Y, Z. That's me vs. some heavy intellectual psychoanalytical view of why they are this way.

Is there room in Psychiatry for people like me? I'm an extremely optimistic person and can relate well with patients, but I am not articulate in the way I described above.

Both approaches are probably not a good fit for what most psychiatric patients actually need.

Most need motivational inspiration/enhancement, development of self-efficacy and internal locus of control, healthier relationships, healthier lifestyle (diet, exercise, more sleep, less alcohol), more money. Some need antipsychotics or lithium.
 
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TLDR: I feel like I am too simple minded (problem -> fix it) (concrete thinker) to do Psychiatry sometimes. I don't usually offer hyper-intellectual answers (even without the terminology). I am more of a: I really enjoyed talking to the patient and throughout the course of our conversation they really gave off the impression that they may be depressed. They met all SIG E CAPS requirements. I think they could really benefit from Celexa because of X, Y, Z. That's me vs. some heavy intellectual psychoanalytical view of why they are this way.
Those smug analysts who think they know what patients really mean are a nuisance and make for terrible psychiatrists. sometimes a cigar really just is a cigar. and sometimess it's a penis.

at the same time you will be sorely disappointed if you think the technological mechanistic reductive "problem -> fix it" model can be applied to psychiatry in most instances. sometimes it really is that simple. mostly it is not. If you think psychiatry is just SIG E CAPS and being a human candy machine, then you might be right but that is not good psychiatry and you won't help many patients that way.

I am quite philosophically inclined but most patients have no interest in (nor are they helped) by meandering philosophical musings on the part of their psychiatrist, or the mental masturbation and fatuous interpretations of a supercilious analyst. What heals is connection. What helps is being understood. What counts is narrative. Take the time to listen to the story of your patient's illness, bear witness to their suffering, and show that you care for them, and you will be able to help empower them to make the best decisions on their pathway to recovery. And that's what makes a great psychiatrist.
 
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Those smug analysts who think they know what patients really mean are a nuisance and make for terrible psychiatrists. sometimes a cigar really just is a cigar. and sometimess it's a penis.

at the same time you will be sorely disappointed if you think the technological mechanistic reductive "problem -> fix it" model can be applied to psychiatry in most instances. sometimes it really is that simple. mostly it is not. If you think psychiatry is just SIG E CAPS and being a human candy machine, then you might be right but that is not good psychiatry and you won't help many patients that way.

I am quite philosophically inclined but most patients have no interest in (nor are they helped) by meandering philosophical musings on the part of their psychiatrist, or the mental masturbation and fatuous interpretations of a supercilious analyst. What heals is connection. What helps is being understood. What counts is narrative. Take the time to listen to the story of your patient's illness, bear witness to their suffering, and show that you care for them, and you will be able to help empower them to make the best decisions on their pathway to recovery. And that's what makes a great psychiatrist.

I have to agree with Splik, per usual.

I would dare say that most patients seeking psychological/psychiatric services, at least in the western world, (outside SMI patients) are "sunsets" rather than a "math problem"...if you get the analogy?
 
The dirty secret: most people have common problems with common things. Most of the people who are convinced that they have something weird and unusual and intellectually challenging, are people who have the same common problems as every other guy but are dramatizing or intellectualizing their own lives. So you learn some basic therapy techniques, adjust them to suit your style and the patient's issues and education level, and see where it takes you. Imitate your teachers and mentors, try stuff you read about, and when something seems to work well, make it part of your repertoire. It's more like learning to play folk music than it's like flying a 747.

Anyway: Most people would rather have a warm, competent psychiatrist who doesn't give up on them rather than a caricature psychoanalyst like Frasier's brother.
 
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Those smug analysts who think they know what patients really mean are a nuisance and make for terrible psychiatrists. sometimes a cigar really just is a cigar. and sometimess it's a penis.

at the same time you will be sorely disappointed if you think the technological mechanistic reductive "problem -> fix it" model can be applied to psychiatry in most instances. sometimes it really is that simple. mostly it is not. If you think psychiatry is just SIG E CAPS and being a human candy machine, then you might be right but that is not good psychiatry and you won't help many patients that way.

I am quite philosophically inclined but most patients have no interest in (nor are they helped) by meandering philosophical musings on the part of their psychiatrist, or the mental masturbation and fatuous interpretations of a supercilious analyst. What heals is connection. What helps is being understood. What counts is narrative. Take the time to listen to the story of your patient's illness, bear witness to their suffering, and show that you care for them, and you will be able to help empower them to make the best decisions on their pathway to recovery. And that's what makes a great psychiatrist.

I like Psychiatry because you can "cut" into someone's brain without ever using a scalpel. You know what I am getting at and it is something OPD says all the time. I may not be as philosophical, but if I learn and grow over the course of a 4 year residency, then I will be armed with the tools I need to serve the mentally ill. Nothing is more satisfying than seeing a mentally ill person returned to a functioning state: relationships with friends and family, employment etc. I know there will be setbacks and the job can be frustrating at times. I think the right frame of mind can help with that (that's where Psych's lifestyle helps). I truly just want to have conversations with patients, be their advocate, help them achieve functionality/mental health through meds/talk therapy, and go home knowing I tried.
 
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Is it possible to be too intellectual during analysis? I sometimes feel like Psychiatrists are portrayed as overly intellectual, well dressed, articulate (think upper east side of Manhattan, legs crossed drinking tea with sweater vest). For instance, I get one understanding from a patient during my analysis but they say no no, it really meant this. It's kind of intimidating. I know your abilities improve from PGY-1 to 4 and I know some Psychiatrists are better at some things than others.

TLDR: I feel like I am too simple minded (problem -> fix it) (concrete thinker) to do Psychiatry sometimes. I don't usually offer hyper-intellectual answers (even without the terminology). I am more of a: I really enjoyed talking to the patient and throughout the course of our conversation they really gave off the impression that they may be depressed. They met all SIG E CAPS requirements. I think they could really benefit from Celexa because of X, Y, Z. That's me vs. some heavy intellectual psychoanalytical view of why they are this way.

Is there room in Psychiatry for people like me? I'm an extremely optimistic person and can relate well with patients, but I am not articulate in the way I described above.

There is definitely room for people like you in psychiatry. In particular, you will make better medication prescription choices by sticking to a rather 'concrete' framework as this is how people were selected for clinical trials, and are the only empirical basis by which we can say someone is likely to respond to a medication - people will certainly talk about receptors or nuance of psychopathology but this is not a rational way to inform these choices.

Regarding therapy, I agree with what others have said. I'd add that even within the field of psychoanalysis there is an understanding that being to 'intellectual' can be a problem for both the patient and the therapist. Even the best interpretations should be held back if they will get in the way of providing an authentic experience where the patient feels heard and free to explore their thoughts and feelings. Less experienced therapists are more likely to make frequent intepretations out of a need to prove competency to themselves and their patients. Sometimes doing and saying nothing requires tremendous self assurance on the part of the therapist, but can communicate to the patient a powerful sense that the process is about them.
 
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Those smug analysts who think they know what patients really mean are a nuisance and make for terrible psychiatrists. sometimes a cigar really just is a cigar. and sometimess it's a penis.

at the same time you will be sorely disappointed if you think the technological mechanistic reductive "problem -> fix it" model can be applied to psychiatry in most instances. sometimes it really is that simple. mostly it is not. If you think psychiatry is just SIG E CAPS and being a human candy machine, then you might be right but that is not good psychiatry and you won't help many patients that way.

I am quite philosophically inclined but most patients have no interest in (nor are they helped) by meandering philosophical musings on the part of their psychiatrist, or the mental masturbation and fatuous interpretations of a supercilious analyst. What heals is connection. What helps is being understood. What counts is narrative. Take the time to listen to the story of your patient's illness, bear witness to their suffering, and show that you care for them, and you will be able to help empower them to make the best decisions on their pathway to recovery. And that's what makes a great psychiatrist.

This is off-topic but I'm so glad you're back on the forum! BTW, please don't leave the country!
 
I am quite philosophically inclined but most patients have no interest in (nor are they helped) by meandering philosophical musings on the part of their psychiatrist, or the mental masturbation and fatuous interpretations of a supercilious analyst. What heals is connection. What helps is being understood. What counts is narrative. Take the time to listen to the story of your patient's illness, bear witness to their suffering, and show that you care for them, and you will be able to help empower them to make the best decisions on their pathway to recovery. And that's what makes a great psychiatrist.

That's very true but that is also not at odds with a "biological" or scientific approach to psychiatry. Empathy heals and there's also science behind that. Nothing can stope one from being a caring and empathic psychiatrist and be guided by empirical science at the same time. Psychoanalysis and analysis can also be extremely objectifying of patients and honestly sometimes the arrogance that goes along with "interpretations" is mystifying given the scarcity of evidence to guide the explanations to start with.
 
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On the one hand, patients do appreciate the brilliant things that I say on rare occasions. What is probably more helpful though are the times that I acknowledge the dumb things that I say on a more frequent basis. In fact, with patients with more borderline personality organization, helping them to integrate the brilliant psychologist with the flawed human is the treatment. It is always a little bit of a funny process as I try to help them to pierce the idealizing transference and one of the parts of the job that I really enjoy.
 
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On the one hand, patients do appreciate the brilliant things that I say on rare occasions....
What I find fascinating is the stuff they remember as being "brilliant"--if I remember it at all, it was almost always something random, or unintentional, or unexpected in its impact. I've gotten thank you cards 2-3 years later saying "You changed my life when you said _____", and I'm like "Wha...?"
 
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I actually think you could conduct an extremely successful psychotherapy practice by doing nothing but Reflection - i.e., summarizing the content of what the person told you and, when appropriate, articulating their apparent feelings about it.

This sounds completely trivial but in practice people find it revelatory. They feel heard and understood, and it also helps them see underlying conflicts or inconsistencies that drive their negative emotions without their previously having been aware.
 
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From a patient's point of view, a good Psychiatrist is:

Empathetic
Attentive ("Present")
Responsive
Flexible

and most importantly...

Balanced in their approach to any or all of the above (for example, neither being overtly dismissive nor jumping straight into rescuer mode)

The fact that I can occasionally have some very interesting philosophical and analytical discussions with my current Psychiatrist is really just a bonus to me.
 
If ever there was an oxymoron, your post title was it. Is that concrete enough? And guess what? There is nothing special about the UES - jus took at how long they've been working on the 2nd Avenue line. Hardly the work of sweater-vest-wearing-tea-sipping intellectuals.
 
I actually think you could conduct an extremely successful psychotherapy practice by doing nothing but Reflection - i.e., summarizing the content of what the person told you and, when appropriate, articulating their apparent feelings about it.

This sounds completely trivial but in practice people find it revelatory. They feel heard and understood, and it also helps them see underlying conflicts or inconsistencies that drive their negative emotions without their previously having been aware.

LOL, I agree. However, I'm driving a completely opposite approach in my practice, which is perhaps equally "trivial".

I ask my patients to give me a list of tasks they should do. Then I tell them to do them. Then a week later I ask them nicely if they did them. Maybe there's nothing more "concrete thinking" than that. Somehow this seems to work also. I don't talk or care about what people think anymore. I only care about what people actually do.
 
LOL, I agree. However, I'm driving a completely opposite approach in my practice, which is perhaps equally "trivial".

I ask my patients to give me a list of tasks they should do. Then I tell them to do them. Then a week later I ask them nicely if they did them. Maybe there's nothing more "concrete thinking" than that. Somehow this seems to work also. I don't talk or care about what people think anymore. I only care about what people actually do.
Behavioral therapy at it's finest using a social reinforcer. Good job! (See, I just did it too :D) If you are really up to taking it to the next level, then you can also ask what got in the way if they didn't do it and what could make it more likely to do it next time. The biggest mistake that I see the articulate and brilliant practitioners make is to neglect looking at the straightforward, relatively simple, and highly effective principles of behaviorism.
 
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LOL, I agree. However, I'm driving a completely opposite approach in my practice, which is perhaps equally "trivial".

I ask my patients to give me a list of tasks they should do. Then I tell them to do them. Then a week later I ask them nicely if they did them. Maybe there's nothing more "concrete thinking" than that. Somehow this seems to work also. I don't talk or care about what people think anymore. I only care about what people actually do.

Behavioral activation! I do this a lot for people with trouble with motivation/procrastination. But instead of waiting for the next visit I have them self-determine a deadline (e.g., 4pm on Wednesday) and then they have to call me at that time and leave a message that either says 'Yes I did the task' or explains why they were not able to do the task by the deadline. They pretty much always end up doing the task.
 
I actually think you could conduct an extremely successful psychotherapy practice by doing nothing but Reflection - i.e., summarizing the content of what the person told you and, when appropriate, articulating their apparent feelings about it.

This sounds completely trivial but in practice people find it revelatory. They feel heard and understood, and it also helps them see underlying conflicts or inconsistencies that drive their negative emotions without their previously having been aware.

Yep. It's a very real, and often very difficult, skill to learn and known what not to say and when not to talk. Early on, if a trainee ends up "turning off" a patient, it's often not because they don't demonstrate enough expertise or knowledge, but because they just talk too much.

Likewise, a big part of what we end up doing in mental healthcare is listening to the patient, interpreting what they're saying through the lens of our training, and reflecting and discussing it in a way that they not only understand, but that will help facilitate change. Active reflection, including subtle changes made to work toward an established goal, is in my opinion one of the most difficult therapeutic skills to "master."

I probably fail at this more than I succeed, but eh, it's an ideal.
 
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