Holiday Stress

[maranatha]

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So this is my first year with a full case load of long-term outpatients (not including some psychodynamic cases I started in 2nd year). I have noticed that a few of my previous stable patients have started to become worse as the holiday season came up.

I know that suicide rates do not increase over the Holidays, but I sure have a lot of stressed out patients! Perhaps my experience is just coincidence or b/c of the change in weather?

Anyone else running into this? Or, perhaps I’m just projecting my own stress regarding seeing my in-laws later this week…

 

[Regnvejr]

So this is my first year with a full case load of long-term outpatients (not including some psychodynamic cases I started in 2nd year). I have noticed that a few of my previous stable patients have started to become worse as the holiday season came up.

I know that suicide rates do not increase over the Holidays, but I sure have a lot of stressed out patients! Perhaps my experience is just coincidence or b/c of the change in weather?

Anyone else running into this? Or, perhaps I’m just projecting my own stress regarding seeing my in-laws later this week…

Your last point ties in with why Thanksgiving-NewYear is the busiest time of year.

There are sometimes problems with family time. Either, you are not around the family that you want to be with, or you are seeing family that you should never, ever be around.

 

[whopper]

It's a combo of mood being worse during the Holidays, and some people having no friends or family to spend their X-Mas or Thanksgiving.

All my patients with depression who have no friends or family appear to get worse during the holidays because it just reminds them of their loneliness.

I sometimes wonder if there's a way for these people to somehow develop some type of close bonds with other people in a structured manner that does not violate boundaries that we could facilitate. I have several lonely patients, and borderline patients who never had a loving and caring relationship, and that is the entire basis of their disorder.

 

[strangeglove]

I sometimes wonder if there's a way for these people to somehow develop some type of close bonds with other people in a structured manner that does not violate boundaries that we could facilitate.

Isn't that what psychotherapy is supposed to be about?

 

[whopper]

Isn't that what psychotherapy is supposed to be about?

Yes, but it can only go so far, and for good reasons. I can't be my patient's buddy. I have several borderline patients, who, for example are it due to a lifelong history of abuse and personal rejection by people who were supposed to give them unconditional love have their Cluster B traits.

If that person were to be in a positive family structure, that would greatly benefit that patient, but I can't bring this person into my own family, or thrust them onto another person's family, and frankly there really is no one who wants to be with many of them because of the borderline.

Catch-22.

The psychotherapy would help, but there's things we can't do to help some of our patients.

One of the times I've seen the state or mental health professionals be able to promote a positive family structure in an effective way is with the use of foster homes for parentless children. As for every other attempt, it either violates the boundaries we need to have, or it was a good idea that did not work in practice.

I think it's a reason why some cults are so aversive to psychiatrists, because they want to act and be that family for these people--that's how they make their money.