Borderline personality disorder: diagnosis

Just as I was formulating a few thoughts on borderline personality disorder (BPD), I see the NY Times beat me to it. Jane E. Brody’s 6/15/09 “Personal Health” column, “An Emotional Hair Trigger, Often Misread,” provides an evocative description of this vexing disorder. Brody’s column seems informed largely by her consultant, Dr. Marsha M. Linehan, […]

NY Times roundup

Here are three recent New York Times articles that caught my eye. On March 13th, Tara Parker-Pope’s health blog “Well” reprinted “The 12 Most Annoying Habits of Therapists.” Actually, the list comes from PsychCentral, a blog written by psychologist John M. Grohol, and in my opinion reads better there. I won’t list all 12 habits […]

Charging patients for missed sessions

When Sigmund Freud originally developed psychoanalysis (the precursor to dynamic psychotherapy), he likened treatment fees to those for music lessons:

“As to time, I follow the principle of payment for a fixed hour exclusively. A given hour is assigned to each patient, and that hour is his and he is responsible for it even if […]

Therapist disclosure: why all the secrecy?

Happy Chinese New Year (Gung Hay Fat Choy!). As you can see from the photo, I attended the New Year’s parade in San Francisco’s Chinatown this year. This disclosure introduces my topic for today, directed toward patients and would-be patients: Why do therapists disclose so little about ourselves? Why all the secrecy?

The standard answer […]

Psychiatric disability

Since psychiatric disability is often invisible and unquantifiable, considering oneself psychiatrically disabled can take on many meanings. Certainly there are those who assess their limitations, whether imposed by thought disorder, anxiety, or mood extremes, and accurately gauge themselves disabled. It is a strength to accept reality for what it is, to live one’s […]

The customer is not always right

I often remind psychiatry residents that while a patient’s treatment preference is important, it does not take the place of their own evaluation. It is a bittersweet irony that many of us are mistaken about, or repelled by, what would most help us.

Some patients, with depression for example, only consider medications, and have tried […]

Online anonymity and transference

I’ve been online quite a few years now. Actually, I first used the internet in college in the late 1970s. There were only a handful of non-governmental university sites back then, and I happened to be an undergraduate at one of them. A decade later, in the late 1980s, I was a member of the […]