Not Sure Anymore......

[Ceke2002]

Once again...the lady doth protest too much you're pointing your own way. What did you learn then as a kid who couldn't challenge and just shut up and listened thst you still do now when you don't have to. Where do you get the safety to creatively try out a new way....A safe bet is in therapy. Primary relationships echo and echo. If relationship dynamis now don't work there are many ways in. Via primary relationships is often powerful. Or something like nvc and rosenbergor here and now relational therapy if mother isn't your shtick. Or just grin and bare it whatever is useful that moment.

Hmm, yes, definitely this is the sort of thing that can be explored in therapy, I'm just not sure if my therapist would appreciate me rocking up for an emergency analysis session on the basis of, "well ya see, Doc, I haven't been well lately, and I'm running on lowered reserves, which means a lot of things are just niggling at me way more than they should, and my husband is going through a bit of a bad patch as well, and it's not really helping that we're both getting snippy with one another, so I totally need to come in for an indepth object relations/attachment theory session so I can talk some more about my childhood."

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[oldanddone]

Hmm, yes, definitely this is the sort of thing that can be explored in therapy, I'm just not sure if my therapist would appreciate me rocking up for an emergency analysis session on the basis of, "well ya see, Doc, I haven't been well lately, and I'm running on lowered reserves, which means a lot of things are just niggling at me way more than they should, and my husband is going through a bit of a bad patch as well, and it's not really helping that we're both getting snippy with one another, so I totally need to come in for an indepth object relations/attachment theory session so I can talk some more about my childhood."

Whether emergency call or reg scheduled appointment is part of the dynamic if learned in childhood to have to shut up in face of others drama likely reg scheduled if learned to scream and yell perhaps emergency

 

[oldanddone]

Therapist Pro Tip: You're not actually supposed to jump down in the hole with us.

And yes normative feelings are normative, and not everything needs to be run through the analysis mill. I have clinical depression, my husband has clinical depression, you'd think that would make us both the bastions of mutual understanding but no, not always. I could come up with some BS about how I'm subconsciously transferring past frustrations with my Mother's constant need to play the sick role onto my husband, or I could just accept that it's perfectly normal to feel frustrated/exasperated/exhausted/oh god please stop taking you're hurting my brain in this kind of situation - especially if you're own reserves are running low as well.

Also...the therapist trick is how to dive deep....with energy and choice...
And surface. Sometimes that trip is for one, for two, for three in couples or more if polyamorous or family, or for 8-12 in a typical therapy group. Or for whole communities.

 

[Ceke2002]

Whether emergency call or reg scheduled appointment is part of the dynamic if learned in childhood to have to shut up in face of others drama likely reg scheduled if learned to scream and yell perhaps emergency

And sometimes a cigar is just a cigar, and sometimes people have perfectly normal and understandable reactions to certain things/situations etc and not every little tiny nuance needs to be run through the entire gamut of analysis. I do a lot of psychodynamic, object relations, cognitive analytical and attachment theory based therapy with my Psychiatrist, that doesn't mean I spend every waking moment stuck in analysis mode when I don't need to be.

 

[oldanddone]

And sometimes a cigar is just a cigar, and sometimes people have perfectly normal and understandable reactions to certain things/situations etc and not every little tiny nuance needs to be run through the entire gamut of analysis. I do a lot of psychodynamic, object relations, cognitive analytical and attachment theory based therapy with my Psychiatrist, that doesn't mean I spend every waking moment stuck in analysis mode when I don't need to be.

However when processing reaction to patients it's reflection time as part of it if taking professional development to heart. Also ceke...I believe you are interested in mental health/therapy. Your background gives you good stuff for being a therapist. For the love of humanity choose an experientally heavy training programme you have the experience already of not being afraid to explore yourself.

 

[Ceke2002]

Also...the therapist trick is how to dive deep....with energy and choice...
And surface. Sometimes that trip is for one, for two, for three in couples or more if polyamorous or family, or for 8-12 in a typical therapy group. Or for whole communities.

So wait, you think a therapist can't be diving deep if they're not constantly providing transference analysis based reasons for every single thing their patient may bring into therapy?

 

[Ceke2002]

However when processing reaction to patients it's reflection time as part of it if taking professional development to heart. Also ceke...I believe you are interested in mental health/therapy. Your background gives you good stuff for being a therapist. For the love of humanity choose an experientally heavy training programme you have the experience already of not being afraid to explore yourself.

Thank you, and yes in terms of processing reactions to patients that's different and one would hope far more reflective - at the same time I just don't think the answer always lies in the more traditional ideas of transference/countertransference. Sometimes when you reflect on something the answer can end up being far simpler (you were having an off day, the patient really was a pain in the proverbial, etc etc).

I've discussed transference/countertransference theories with my Psychiatrist a couple of times, the best example he gave of when countertransference really isn't countertransference was when he used an illustrative example of taking a Psych registrar through a supervised session with an extremely manic and verbally aggressive patient. At the end of the session the registrar asked if the fear they felt when confronted with such a patient was a sign of countertransference - my Psychiatrist's response? (paraphrased) 'More like your instinct recognising a potential threat'.

I guess I just believe there's a time and a place for everything, in some cases a more indepth analysis of a therapist's countertransference towards a patient is needed, and sometimes it's just enough to recognise that feeling of fear that a patient is invoking in you might just be because the patient is about to clock you one.

 

[Ceke2002]

I hope you don't mind me asking, but how often do you see your psychiatrist?

No, I don't mind. Generally once every 3-4 weeks with the option of extra sessions in between time if needed. That's currently, sessions were more frequent when I was first starting out/less stable. I actually requested that period of time between sessions, we do get into some pretty heavy stuff sometimes and I like having that period of time afterwards to explore what was discussed in my own time. I think I was having weekly sessions I'd end up becoming too overwhelmed for the therapy to be doing me much good.

 

[Ceke2002]

I hope you don't mind me asking, but how often do you see your psychiatrist?

No, I don't mind. Generally once every 3-4 weeks with the option of extra sessions in between time if needed. That's currently, sessions were more frequent when I was first starting out/less stable. I actually requested that period of time between sessions, we do get into some pretty heavy stuff sometimes and I like having that period of time afterwards to explore what was discussed in my own time. I think I was having weekly sessions I'd end up becoming too overwhelmed for the therapy to be doing me much good.

Sorry, just to add, the types of issues that would get discussed more along the lines of transference related stuff in one of my sessions would be things like me having a tendency to be overly compliant and feeling the need to constantly apologise for not being a very good patient; me emotionally detaching (then disregulating) during a grief event because I'm too busy making sure everyone else is okay and telling myself I haven't 'earned' the 'right' to grieve; my past experiences with emotional rescuers, and my initial response to my Psychiatrist based on past experience with an abusive therapist. Things that wouldn't be discussed as transference based issues would be stuff like simple life stressors.

And yes I realise psychodynamic based therapy usually takes place more than once every 3-4 weeks as well, but we've had a system in place for a few years now, and it works well for us.

 

[oldanddone]

So wait, you think a therapist can't be diving deep if they're not constantly providing transference analysis based reasons for every single thing their patient may bring into therapy?

No I didn't say the therapist provides transference analysis. I'm not psychoanalytic. Even there that part of a session is fairly minimal. Transference from an analytic perspective may not be your /my shtick. I'm saying I'd find myself more resistant to diVing deep with myself or others if I hadn't gotten interested in what is present in the field/cocreation of space each moment and working through some of my own resistances which allows me to have more vitality in the presence of other people's resistances. Less 'confluence' (gestalt word). In fact some of this stuff happens even outside of formal therapy theories. In addictions world of aa and sobriety this is about 'responsibility for your side of the street' or in gestalt terms '**** sorting'. What ****'s yours what ****'s mine and getting it into the right underpants.

 

[Ceke2002]

No I didn't say the therapist provides transference analysis. I'm not psychoanalytic. Even there that part of a session is fairly minimal. Transference from an analytic perspective may not be your /my shtick. I'm saying I'd find myself more resistant to diVing deep with myself or others if I hadn't gotten interested in what is present in the field/cocreation of space each moment and working through some of my own resistances which allows me to have more vitality in the presence of other people's resistances. Less 'confluence' (gestalt word). In fact some of this stuff happens even outside of formal therapy theories. In addictions world of aa and sobriety this is about 'responsibility for your side of the street' or in gestalt terms '**** sorting'. What ****'s yours what ****'s mine and getting it into the right underpants.

Ah okay, thanks for the further explanation, that makes sense.

 

[oldanddone]

Ah okay, thanks for the further explanation, that makes sense.

Cutand paste below on the technical gestalt use of '****' and haven't attributed source...some Web page somewhere
Ceke I think maybe you're reacting to elephant ****?

Fritz Perls (1893–1970) was one of the founders of Gestalt Therapy, and he was a
lively and controversial figure of this popular psychotherapy of the 1960s. His
early influences included German neurologist Kurt Goldstein and highly
controversial neo-Freudian Wilhelm Reich. In Perls’ book, Gestalt Therapy
Verbatim (1969a), he outlined in only 71 pages its philosophical bases in a series
of public lectures. Whereas Freud believed that dreams were the royal road to
the unconscious, Perls thought that dreams served as ‘the royal road to
integration.’ Dreaming, for Perls, was the most spontaneous thing that people
do. He thought that language, specifically the things that we typically said, were
mostly types of ****: chicken**** consisted of trite phrases like hello, how are you,
etc.; bull**** occurred mostly in response to asking a person: why? Because Perls,
like Freud, believed that psychic events were overdetermined, that is, they have
many causes, there was no possible way that someone could come up with the
answer to why they had done something. Finally, in his spontaneous and
provocative humor, he added elephant****, for which he gave Gestalt Therapy as
an example, and he reserved the term for grand theories.
‘So where was he coming from?’ as we said in the 196

 

[oldanddone]

Cutand paste below on the technical gestalt use of '****' and haven't attributed source...some Web page somewhere
Ceke I think maybe you're reacting to elephant ****?

Fritz Perls (1893–1970) was one of the founders of Gestalt Therapy, and he was a
lively and controversial figure of this popular psychotherapy of the 1960s. His
early influences included German neurologist Kurt Goldstein and highly
controversial neo-Freudian Wilhelm Reich. In Perls’ book, Gestalt Therapy
Verbatim (1969a), he outlined in only 71 pages its philosophical bases in a series
of public lectures. Whereas Freud believed that dreams were the royal road to
the unconscious, Perls thought that dreams served as ‘the royal road to
integration.’ Dreaming, for Perls, was the most spontaneous thing that people
do. He thought that language, specifically the things that we typically said, were
mostly types of ****: chicken**** consisted of trite phrases like hello, how are you,
etc.; bull**** occurred mostly in response to asking a person: why? Because Perls,
like Freud, believed that psychic events were overdetermined, that is, they have
many causes, there was no possible way that someone could come up with the
answer to why they had done something. Finally, in his spontaneous and
provocative humor, he added elephant****, for which he gave Gestalt Therapy as
an example, and he reserved the term for grand theories.
‘So where was he coming from?’ as we said in the 196

Actually ceke maybe you are also calling a bit of bull**** too. Gestalt has been considered phenomenological and rich in all the w5h with an avoidance of why. Psychoanalysisay have more of a why. Just to add fritz is not where gestalt stopped or all even of where it started. His wife laura stayed in new York and was very relational. Fritz was more a showman and went to the west coast. The seminal text also was written woth an American anarchist and the autonomy of anarchism alla Emma Goldman another new yorker is throughout its roots.

 

[oldanddone]

No I didn't say the therapist provides transference analysis. I'm not psychoanalytic. Even there that part of a session is fairly minimal. Transference from an analytic perspective may not be your /my shtick. I'm saying I'd find myself more resistant to diVing deep with myself or others if I hadn't gotten interested in what is present in the field/cocreation of space each moment and working through some of my own resistances which allows me to have more vitality in the presence of other people's resistances. Less 'confluence' (gestalt word). In fact some of this stuff happens even outside of formal therapy theories. In addictions world of aa and sobriety this is about 'responsibility for your side of the street' or in gestalt terms '**** sorting'. What ****'s yours what ****'s mine and getting it into the right underpants.

I'd like to add to this that transference analysis would be going on throughout the entire session in an integrated experiential way. However stating to a patient an interpretationay happen very rarely.

 

[Ceke2002]

Cutand paste below on the technical gestalt use of '****' and haven't attributed source...some Web page somewhere
Ceke I think maybe you're reacting to elephant ****?

Fritz Perls (1893–1970) was one of the founders of Gestalt Therapy, and he was a
lively and controversial figure of this popular psychotherapy of the 1960s. His
early influences included German neurologist Kurt Goldstein and highly
controversial neo-Freudian Wilhelm Reich. In Perls’ book, Gestalt Therapy
Verbatim (1969a), he outlined in only 71 pages its philosophical bases in a series
of public lectures. Whereas Freud believed that dreams were the royal road to
the unconscious, Perls thought that dreams served as ‘the royal road to
integration.’ Dreaming, for Perls, was the most spontaneous thing that people
do. He thought that language, specifically the things that we typically said, were
mostly types of ****: chicken**** consisted of trite phrases like hello, how are you,
etc.; bull**** occurred mostly in response to asking a person: why? Because Perls,
like Freud, believed that psychic events were overdetermined, that is, they have
many causes, there was no possible way that someone could come up with the
answer to why they had done something. Finally, in his spontaneous and
provocative humor, he added elephant****, for which he gave Gestalt Therapy as
an example, and he reserved the term for grand theories.
‘So where was he coming from?’ as we said in the 196

Actually ceke maybe you are also calling a bit of bull**** too. Gestalt has been considered phenomenological and rich in all the w5h with an avoidance of why. Psychoanalysisay have more of a why. Just to add fritz is not where gestalt stopped or all even of where it started. His wife laura stayed in new York and was very relational. Fritz was more a showman and went to the west coast. The seminal text also was written woth an American anarchist and the autonomy of anarchism alla Emma Goldman another new yorker is throughout its roots.

I'd like to add to this that transference analysis would be going on throughout the entire session in an integrated experiential way. However stating to a patient an interpretationay happen very rarely.

Looks like I'll have to add Gestalt Therapy onto my current reading list.

 

[thoffen]

Every reaction you have with a patient is countertransference. The way you are interacting is always based on models of interaction from your past. It's how each of all of us has learned to interact.

Still doesn't mean we should go diving deep into everything that happens to find its "meaning". This is not about a search for meaning. It's an opportunity to recognize patterns based on past experience and thereby exposing yourself to different ways of approaching something.

 

[BackToday]

I will say that I find it strange that people are so focused on my family maybe not approving of psych, but almost no one has mentioned me seeing an attending being assaulted, lol. Maybe that's what's holding me back?

 

[MacDonaldTriad]

I've seen MDs assaulted in non-psych settings, at least on inpatient you probably have safety in mind as you move about. If you are questioning going into psych because you are afraid of being assaulted, at least that holds more weight than letting some distant relative's lay person opinion about the field hold you back. I do get it however. Scientologists are so over the top anti psych, they lose credibility, but when it is someone who is close, it is harder to ignore.

 

[thoffen]

I will say that I find it strange that people are so focused on my family maybe not approving of psych, but almost no one has mentioned me seeing an attending being assaulted, lol. Maybe that's what's holding me back?

There are some threads on this. There's some validity to the risk (especially in certain settings), but it is not common, and the only time I've seen violence from a patient that wasn't (unintentionally) also egged on by staff was in case of acute intoxication in the ED. Personally, I'd feel uncomfortable in any medical field without my psychiatric training and practice with therapeutic boundaries. Although, ignorance would likely have been bliss.

 

[BackToday]

I'll be honest. I've mainly forgotten what the relative's problems were. For some reason, I really think it was the attending's approach and seeing another attending get assaulted. I genuinely do believe that depression is real, but I don't believe that everyone who's sad is depressed. And I just don't think I could excuse every patient's behavior with depression.

 

[Jules A]

I will say that I find it strange that people are so focused on my family maybe not approving of psych, but almost no one has mentioned me seeing an attending being assaulted, lol. Maybe that's what's holding me back?

Meh, to me the slight chance of getting assaulted on my inpatient units or in the ED is a bit of an adrenalin rush and I figure might give me some street cred, lol.

 

[oldanddone]

I'll be honest. I've mainly forgotten what the relative's problems were. For some reason, I really think it was the attending's approach and seeing another attending get assaulted. I genuinely do believe that depression is real, but I don't believe that everyone who's sad is depressed. And I just don't think I could excuse every patient's behavior with depression.

I know you're getting more defensive/defended and I'm still poking....forgetting can be a form of defense

 

[northernpsy]

I would be much more nervous about being an RN on a psych unit than I am as a psychiatrist since the nurses get the worst of patients' behaviors a lot of times.
I always have in the back of my mind that patients can potentially become aggressive and so I do try to stay mindful of taking safety precautions such as never letting patients get between the door and me. I think the risk also depends a lot on what kind of environment you are working in.

 

[nancysinatra]

Antagonism to psychiatry is mostly generated by ignorance because lay people have such a distorted view of what we do.

I'm pretty antagonistic to the field - mainly because of the pseudoscience and subjective hand waving, and I'm pretty sure I'm not "ignorant." Nor am I a lay person.

No one really wants to to hear the painful things that our patients tell us or experience the painful feelings.

If no one wants to hear painful things said by patients, then why do some people become psychiatrists?

I think we've all reached a point in our careers where we've felt demoralized, and that we've medicalized people who are simply locked in a miserable cycle of overeating, oversleeping and underworking. They're not going to get better on a psych floor.

But if you think you can avoid these people by going into another speciality, you're going nowhere.

You are wrong to say that lazy patients cannot be avoided. Witness sports medicine. And space medicine. Not to mention reproductive endocrinology and plastic surgery, specialties that cater to the rich and beautiful.

I will say that I find it strange that people are so focused on my family maybe not approving of psych, but almost no one has mentioned me seeing an attending being assaulted, lol. Maybe that's what's holding me back?

Being assaulted is a day in, day out risk in certain areas of psychiatry. Perhaps no one is mentioning it because no one has a good response. Just so you know, though, this risk exists in other specialties too. ER docs, for example.

 

[smalltownpsych]

I'm pretty antagonistic to the field - mainly because of the pseudoscience and subjective hand waving, and I'm pretty sure I'm not "ignorant." Nor am I a lay person.



If no one wants to hear painful things said by patients, then why do some people become psychiatrists?



You are wrong to say that lazy patients cannot be avoided. Witness sports medicine. And space medicine. Not to mention reproductive endocrinology and plastic surgery, specialties that cater to the rich and beautiful.



Being assaulted is a day in, day out risk in certain areas of psychiatry. Perhaps no one is mentioning it because no one has a good response. Just so you know, though, this risk exists in other specialties too. ER docs, for example.

I should have clarified by saying normal people don't want to listen to painful things. You are right though, I overstated it, but the point I was making is that we are trained or learn to react differently. Almost all docs would meet this or any emergency personnel. I don't think it is unusual or special for our field except that it is more intangible. Not many people think they can run into a burning building without training or start cutting people open, but lots of people think they can do our job.